中国胸心血管外科临床杂志

中国胸心血管外科临床杂志

孙氏手术处理急性 A 型主动脉夹层合并灌注不良综合征的近期结果

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目的 探讨孙氏手术处理急性 A 型主动脉夹层合并灌注不良综合征的临床效果。 方法 2014 年 1 月至 2017 年 12 月期间南京医科大学第二附属医院连续收治 A 型主动脉夹层合并灌注不良综合征的患者 30 例,平均年龄(48.26±15.17)岁。所有患者在深低温停循环,顺行性选择性脑灌注或经上腔静脉逆行性脑灌注下行四分支人工血管全主动脉弓替换加支架象鼻人工血管植入术(孙氏手术),近端行 Bentall 手术 18 例,单纯升主动脉替换 12 例。同期行冠状动脉旁路移植术 3 例。 结果 全组平均体外循环时间(256.37±61.28)min,主动脉阻断时间(124.75±42.18)min,深低温停循环时间(38.17±10.65)min。住院死亡 5 例。术后随访 3~42 月,平均 24 个月,随访率 100%,死亡 2 例。 结论 A 型主动脉夹层合并灌注不良综合征明显增加了手术风险,但通过孙氏手术仍能够获得较满意的结果。

关键词: 主动脉夹层; 灌注不良综合征; 孙氏手术

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