CAJ | 학술논문

目的分析Stanford A型主动脉夹层围术期低氧的原因,总结其治疗策略.方法回顾性分析我院2005年12月至2011年7月64例Stanford A型主动脉夹层手术患者临床资料,其中慢性夹层9例,55例急性夹层.术前氧合指数＜ 200 mm Hg有51例.所有病例深低温停循环下完成手术.结果 3例死亡.术后呼吸机辅助持续72 h氧合指数＜200 mm Hg有33例,1例气管切开呼吸机辅助9d后撤机,余病例均在呼吸机辅助通气72～120 h后顺利撤机.统计分析发现术后低氧与术前氧合指数＜200mm Hg(P =0.002)、急性夹层(P=0.048)、BMI(P=0.046)、停循环时间(P=0.03)、术中输血量≥3000ml(P =0.001)有关.结论重视Stanford A型主动脉夹层围术期低氧的相关因素,有助于此型患者度过术后严重低氧阶段,改善预后.
목적 분석Stanford A형주동맥협층위술기저양적원인,총결기치료책략.방법 회고성분석아원2005년12월지2011년7월64례Stanford A형주동맥협층수술환자림상자료,기중만성협층9례,55례급성협층.술전양합지수＜ 200 mm Hg유51례.소유병례심저온정순배하완성수술.결과 3례사망.술후호흡궤보조지속72 h양합지수＜200 mm Hg유33례,1례기관절개호흡궤보조9d후철궤,여병례균재호흡궤보조통기72～120 h후순리철궤.통계분석발현술후저양여술전양합지수＜200mm Hg(P =0.002)、급성협층(P=0.048)、BMI(P=0.046)、정순배시간(P=0.03)、술중수혈량≥3000ml(P =0.001)유관.결론 중시Stanford A형주동맥협층위술기저양적상관인소,유조우차형환자도과술후엄중저양계단,개선예후.
Objective To analyze the reasons of perioperative hypoxia in Stanford A aortic dissection,and summarize its management strategies.Methods From Dec.2005 to Jul.2011,sixty four patients underwent surgery for acute type A aortic dissection,of which 9 cases were with chronic dissection and 55 cases with emergent ones.Preoperative oxygen fraction ratio( PaO2/FiO2 )in 51 cases was lower than 200 mm Hg.All of them underwent the surgery with the help of deep hypothermia cardiac arrest technique.Results Three cases died.Thirty-three cases could not live without ventilation during the first 72 h because of continuous hypoxia ( PaO2/FiO2 ＜ 200 mm Hg).One case underwent tracheotomy and auxiliary ventilation for 9 days.The rest were live without ventilation after auxiliary ventilator for 72 - 120 hrs.The data showed that postoperative hypoxia was related to preoperative hypoxia (oxygen fraction ratio ＜ 200 mm Hg),BMI,acute onset,hypothermia cardiac arrest time,and transfusion more than 3000 ml ( P ＜ 0.05 ).Conclusion Great attention should be paid to the perioperative hypoxia-related factors in Stanford A dissection,which will be helpful to improve prognosis.