中国胸心血管外科临床杂志

中国胸心血管外科临床杂志

老年 Stanford A型主动脉夹层外科治疗

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目的 总结老年 Stanford A 型主动脉夹层(Stanford type A aortic dissection,AAD)外科治疗经验,探讨手术方式和要点,以提高外科治疗疗效。 方法 2014 年 12 月至 2017 年 12 月对 23 例老年 Stanford A 型主动脉夹层患者(年龄≥70 岁)行手术治疗,均在全身麻醉、低温停循环及双侧顺行脑灌注下进行。其中男 18 例、女 5 例,年龄(73.6±4.1)岁。 结果 全组体外循环时间(207.5±38.3)min,主动脉阻断时间(148.1±35.7)min,停循环时间(9.4±5.1)min,手术时间(7.2±3.6)h,术后体外膜肺氧合器(extracorporeal memberane oxygenation,ECMO)支持 2 例,透析 4 例,2 例住院期死亡,死亡率 8.9%。全组患者出院前及术后 3 个月复查主动脉全程 CT 提示:覆膜支架及其分支血管通畅无狭窄,支架位置正常,主动脉弓及降主动脉假腔完全血栓化 19 例,部分血栓化 3 例。 结论 对于老年 Stanford A 型主动脉夹层患者,外科治疗仍是首选。减少或避免低温尤其是深低温停循环对患者的负面影响,最大限度缩短全身重要脏器缺血时间及总体手术时间是手术成功的关键。

关键词: 主动脉夹层; 老年; 外科治疗

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