CAJ | 학술논문

目的：探讨Standford B型急性主动脉夹层（ acut aortic dissection ， AAD）患者术前低氧血症的原因分析及诊治。方法回顾我院2012-06～2013-09入院诊断Standford B型AAD 139例，出现低氧血症患者共66例。统计其临床相关资料，分析影响动脉氧分压的病因，并予以治疗。结果主动脉夹层术前低氧血症患者与非低氧血症患者相比各项炎性指标均增高（P＜0.05），66例低氧血症患者中符合急性肺损伤（acute lung injury， ALI）诊断39例（59．09％），合并胸腔积液的为58例（87．88％），符合全身炎症反应综合征（SRIS）诊断的23例（34．85％）。给予适当镇静、改善氧供、稳定血压及心率等药物治疗，部分患者择期行主动脉腔内隔绝术。结论急性主动脉夹层患者低氧血症发生率高，考虑主动脉夹层后机体过度炎性反应出现肺损伤、胸腔积液，甚至ARDS，影响患者呼吸功能，导致患者低氧血症。
목적：탐토Standford B형급성주동맥협층（ acut aortic dissection ， AAD）환자술전저양혈증적원인분석급진치。방법회고아원2012-06～2013-09입원진단Standford B형AAD 139례，출현저양혈증환자공66례。통계기림상상관자료，분석영향동맥양분압적병인，병여이치료。결과주동맥협층술전저양혈증환자여비저양혈증환자상비각항염성지표균증고（P＜0.05），66례저양혈증환자중부합급성폐손상（acute lung injury， ALI）진단39례（59．09％），합병흉강적액적위58례（87．88％），부합전신염증반응종합정（SRIS）진단적23례（34．85％）。급여괄당진정、개선양공、은정혈압급심솔등약물치료，부분환자택기행주동맥강내격절술。결론급성주동맥협층환자저양혈증발생솔고，고필주동맥협층후궤체과도염성반응출현폐손상、흉강적액，심지ARDS，영향환자호흡공능，도치환자저양혈증。
Objective To investigate the causes and management of preoperative hypoxemia in patients with acute Standford type B aortic dissection .Methods From June 2012 to September 2013 , 139 patients of acute Standford type B aortic dissection were collected and 66 cases of them underwent hypoxemia .The clinic correlated information has been summarized and analyzed retrospectively .We investigated the causes of preoperative hypoxemia and treated the condition accordingly .Results In patients with hypoxemia , all indexes that reflect the inflammation were significantly higher than those in patients without hypoxemia ( P <0.05 ).Of the 66 patients who underwent hypoxemia , 39 cases (59.9%) met the diagnostic standard of acute lung injury (ALI), 58 cases (87.88%) complicated with hydrothorax and 23 cases (34.85%) met the diagnostic standard of systemic inflammatory response syndrome.These patients were treated with drugs that used for proper sedation , improvement of oxygen supply, as well as for stabilization of blood pressure and ventricular rate .Part of the patients underwent elective endovascular graft exclusion .Conclusion The incidence of hypoxemia is high in patients with acute type B aortic dissection .In patients with dissection of aorta , lung injury , hydrothorax and even ARDS followed by excessive inflammation reaction would affect respiratory function and further induce hypoxemia .