CAJ | 학술논문

目的：探讨主动脉夹层患者的体外循环管理经验，减少术后并发症的发生。方法：回顾分析我院胸心外科2013年1月至2014年6月收治的113例主动脉夹层患者体外循环方法，未涉及主动脉弓部的手术采用中低温体外循环方法；涉及弓部的手术采用深低温停循环＋右腋动脉插管顺行脑灌注方法。结果：3例死于术后顽固性出血，2例术后心跳复苏时出现顽固性心律失常，经抢救无效后死亡，7例患者术后有神经系统症状，2例患者合并急性肾功能衰竭，4例患者因术后呼吸功能衰竭，其余患者均早期（术后3～10天内）拔除气管导管，恢复良好，顺利出院。结论：主动脉夹层常需要外科手术治疗，术前明确诊断并选择适当的体外循环方式，体外循环中维持内环境稳定，重视器官保护，是手术成功的重要保证。
목적：탐토주동맥협층환자적체외순배관리경험，감소술후병발증적발생。방법：회고분석아원흉심외과2013년1월지2014년6월수치적113례주동맥협층환자체외순배방법，미섭급주동맥궁부적수술채용중저온체외순배방법；섭급궁부적수술채용심저온정순배＋우액동맥삽관순행뇌관주방법。결과：3례사우술후완고성출혈，2례술후심도복소시출현완고성심률실상，경창구무효후사망，7례환자술후유신경계통증상，2례환자합병급성신공능쇠갈，4례환자인술후호흡공능쇠갈，기여환자균조기（술후3～10천내）발제기관도관，회복량호，순리출원。결론：주동맥협층상수요외과수술치료，술전명학진단병선택괄당적체외순배방식，체외순배중유지내배경은정，중시기관보호，시수술성공적중요보증。
Objective:To summarize the experience of cardiopulmonary bypass (CPB)process in emergency surgery of aortic dissection,for reducing the occurrence of postoperative complications. Methods:A retrospective analysis of 113 patients with emergency surgery of aortic dissection between January 2013 and June 2014 was performed. Low-temperature CPB methods were used in those not involving the aortic arch while deep hypothermic circulatory arrest (DH-CA)and right axillary artery intubation and selective antegrade cerebral perfusion(SACP)used in involving the aortic. Results:3 patients died of postoperative intractable hemorrhage,2 cases occurred and died of postoperative refractory arrhythmias,7 patients occurred postoperative symptoms of nervous system,2 pa-tients had acute renal failure,4 patients with postoperative respiratory function failure,the other rest patients recovered well with early (3~10 days)removals of the endotracheal tube,and discharged from hospital smoothly. Conclusion:Acute aortic dissection is often needed emergency surgery,preoperative diagnosis and selects the appropriate way of CPB,maintain a stable internal environment in CPB,and caring the important organs protection are the guarantee of successful op-eration.