摘要
目的:探索急性Stanford A型主动脉夹层(acute type A aortic dissection,ATAAD)合并肠系膜灌注不良综合征(mesenteric malperfusion,MesMPS)的治疗策略。方法:回顾2019年1月至2022年6月间,河南省胸科医院收治并进行手术的35例ATAAD伴MesMPs患者的病例资料,根据患者是否优先开通肠系膜上动脉(superior mesenteric artery,SMA),分为灌注恢复优先组及对照组。结果:35例患者中,灌注恢复优先组16例,对照组19例。两组患者基线特征及围术期并发症发生率无明显差异。35例患者早期死亡8例,灌注恢复优先组早期死亡率(1例,6.3%)显著低于对照组(7例,36.8%)(P=0.047)。中位随访8个月,有1例(灌注优先恢复组)患者死亡,生存率仍有差异趋势(P=0.118)。结论:对于相对稳定的急性主动脉夹层(StanfordA型)伴肠系膜灌注不良综合征患者,灌注恢复优先策略取得了良好的治疗效果;对于极高危破裂风险患者要个性化选择手术策略。
Objective:To explore the treatment strategy for acute type A aortic dissection(ATAAD)and mesenteric malperfusion(MesMPS).Methods:We reviewed 35 patients with ATAAD and MesMPS undergoing operation from January 2019 to June 2022 at Henan Provincial Chest Hospital.According to the priority of reopening superior mesenteric artery(SMA),we divided the patients into the reperfusion-first group and the control group.Results:There were 16 patients in the reperfusion-first group and 19 patients in the control group.There were no differences in baseline characteristics and perioperative complications between the two groups.There were 8 early deaths among the 35 patients,including1(6.3%)in the reperfusion-first group and 7(36.8%)in the control group(P=0.047).Over a median follow-up of 8 months,1 patient died(perfusion-firstgroup)and there was a trend of difference in survival(P=0.118).Conclusions:Reperfusion-first was associated with favorable outcomes in patients with stable ATAAD and MesMPS.Personalized strategies should be adopted for patients with high risk of aneurysm rupture.
作者
李峰
张瑞成
乔博
王珂
李晓召
朱汝军
张华
赵建明
何发明
LI Feng;ZHANG Ruicheng;QIAO Bo;WANG Ke;LI Xiaozhao;ZHU Rujun;ZHANG Hua;ZHAO Jianming;HE Faming(Department of Cardiovascular surgery,Henan Provincial Chest Hospital,Zhengzhou University,Zhengzhou 450000,China)
出处
《心肺血管病杂志》
CAS
2023年第8期829-833,共5页
Journal of Cardiovascular and Pulmonary Diseases
基金
河南省医学科技攻关计划省部共建备选项目(2018010036)。
