2022 年第 2 期 第 17 卷

主动脉弓分支优先技术治疗急性Stanford A型主动脉夹层的优势

Advantages of aortic arch branch-first technique in the treatment of acute Stanford type A aortic dissection

作者：熊健宪1陈泰华2余俊键1李文通1曾山3刘子由1廖根圣4潘旭东5

英文作者：Xiong Jianxian1 Chen Taihua2 Yu Junjian1 Li Wentong1 Zeng Shan3 Liu Ziyou1 Liao Gensheng4 Pan Xudong5

单位：1赣南医学院第一附属医院心脏大血管外科，赣州341000；2赣南医学院第一临床医学院，赣州341000；3赣南医学院第一附属医院心血管内科，赣州341000；4江西省赣州市南康区第一人民医院心胸外科，赣州341400；5首都医科大学附属北京安贞医院心脏外科，北京100029

英文单位：1Department of Cardiothoracic Surgery First Affiliated Hospital of Gannan Medical University Ganzhou 341000 China; 2First Clinical Medical College Gannan Medical University Ganzhou 341000 China; 3Department of Cardiovascular Medicine First Affiliated Hospital of Gannan Medical University Ganzhou 341000 China; 4Department of Cardio-Thoracic Surgery Nankang District First People′s Hospital Jiangxi Province Ganzhou 341400 China; 5Department of Cardiac Surgery Beijing Anzhen Hospital Capital Medical University Beijing 100029 China

关键词：StanfordA型主动脉夹层；分支优先；经典孙氏手术

英文关键词：StanfordtypeAaorticdissection；Branch-first；ClassicSun′sprocedure

• 摘要：

• 目的  研究改良孙氏手术程序即主动脉弓分支优先重建吻合技术在Stanford A型主动脉夹层手术中的优势。方法  收集2018年1月至2020年12月在赣南医学院第一附属医院接受孙氏手术的82例急性Stanford A型主动脉夹层患者的临床资料行回顾性研究。其中分支优先组29例（采用主动脉弓分支优先重建的孙氏手术程序），经典组53例（采用经典的孙氏手术程序）。比较2组患者的一般资料及围术期资料。结果  2组低温停搏时间、术中红细胞/血浆/血小板输注量和二次开胸、术后透析、气管切开、低心排血量综合征比例以及住院期间死亡率差异均无统计学意义（均P>0.05）。分支优先组患者体外循环时间、主动脉阻断时间、重症监护病房停留时间、机械通气时间、恢复清醒时间、术后24 h引流量、神经系统并发症发生率短于/少于/低于经典组，术中最低鼻咽温度高于经典组［（187±38）min比（208±61）min、（103±29）min比（117±41）min、（24.3±1.2）h比（51.1±15.6）h、（18±8）h比（36±14）h、（4.1±1.3）h比（6.3±5.6）h、（492±87）ml比（732±138）ml、6.9%（2/29）比22.6%（12/53）］，差异均有统计学意义（均P<0.05）。结论  主动脉弓分支优先技术的优点是体外循环时间和主动脉阻断心脏缺血时间缩短，全程双侧脑灌注，脑保护更有优势，有助于减少神经系统并发症。

• Objective To study the advantages of modified Sun′s procedure(aortic arch branch-first reconstruction and anastomosis) in Stanford type A aortic dissection. Methods The clinical data of 82 patients with acute Stanford type A aortic dissection who underwent Sun′s procedure in First Affiliated Hospital of Gannan Medical University from January 2018 to December 2020 were collected for retrospective study. There were 29 cases in the branch-first group(Sun′s procedure for aortic arch branch-first reconstruction) and 53 cases in the classic group(Classic Sun′s procedure). The general datas and perioperative datas of the two groups were compared. Results There were no significant differences in hypothermic arrest time, intraoperative red blood cell/plasma/platelet transfusion, secondary thoracotomy, postoperative dialysis, tracheotomy, low cardiac output syndrome ratio and death rate during hospitalization between the two groups(all P>0.05). The cardiopulmonary bypass time, aortic occlusion time, intensive care unit stay time, mechanical ventilation time, recovery time, drainage volume 24 h after operation and the incidence of nervous system complications in the branch-first group were shorter/less/lower than those in the classic group, and the lowest nasopharyngeal temperature during operation in the branch-first group was higher than that in the classic group［（187±38）min vs （208±61）min, （103±29）min vs （117±41）min, （24.3±1.2）h vs （51.1±15.6）h, （18±8）h vs （36±14）h, （4.1±1.3）h vs （6.3±5.6）h, （492±87）ml vs （732±138）ml, 6.9%（2/29） vs 22.6%（12/53）］(all P<0.05). Conclusions The branch-first technology has advantages in shortening the time of cardiopulmonary bypass and cardiac ischemia caused by aortic occlusion, maintaining bilateral cerebral perfusion during the whole process, and protecting brain. It is helpful to reduce the complications of nervous system.