伴凝血功能异常的A型主动脉夹层手术及治疗策略

蔡治祥; 张卫达; 车强; 颜涛; 王晓武; 王显悦

doi:10.13201/j.issn.1001-1439.2019.05.017

伴凝血功能异常的A型主动脉夹层手术及治疗策略

- 中国人民解放军南部战区总医院心脏外科中心(广州, 510010)
基金项目:
重大慢性非传染性疾病防控研究（No：2016YFC1301900）

详细信息

通讯作者: 王显悦,E-mail:37680138@qq.com

中图分类号: R543.1

收稿日期: 2018-12-12

Operation and treatment strategy for type A aortic dissection with abnormal coagulation

- Department of Cardiac Surgery, General Hospital of Guangzhou Military Command, Guangzhou, 510010, China

More Information

Corresponding author: WANG Xianyue, E-mail: 37680138@qq.com

Received Date: 12 December 2018

摘要

摘要: 目的：探讨术前伴凝血功能异常的A型主动脉夹层（AAD）手术方式及相关治疗策略。方法：回顾性分析2014-01-2018-06于南部战区总医院心脏外科中心治疗的230例AAD患者，根据临床病史及检查结果判断术前是否伴有凝血功能异常并进行分组，其中试验组伴凝血异常患者43例，对照组未发现明确凝血异常患者187例。全组患者入院后积极完善术前检查后均行急诊外科手术治疗，凝血异常治疗策略在实验室凝血相关检查结果指导下进行，凝血异常患者优先考虑采用自体主动脉或人工血管补片行吻合口覆盖性包裹治疗。比较两组患者术前一般情况、手术情况、输血相关指标及术后恢复情况。结果：全组AAD患者均完成外科手术操作。与对照组比较，试验组患者术前肝功能异常比例及凝血相关指标异常的发生率较高，全弓置换率较低，手术时间相对较长，围手术期浓缩红细胞、新鲜冰冻血浆、血小板和凝血成分如凝血酶原复合物、重组人凝血因子Ⅶ和纤维蛋白原输注较多，且术后24 h引流量较多，ICU滞留时间较长，再次开胸止血、血滤治疗、纵膈感染及院内死亡比例相对较多（均P<0.05）。两组患者体外循环时间、主动脉阻闭时间及术中最低温度、术后肺部感染率均无明显统计学差异。结论：伴凝血功能异常的AAD患者急诊手术风险高，术后并发症多，对此类患者应给予针对性的相关药物治疗，同时选择相对简易的手术方式，手术效果尚可接受。
- 主动脉夹层,A型 /
- 凝血功能异常 /
- 风险 /
- 策略
Abstract: Objective: To explore the operation and treatment strategy for type A aortic dissection (AAD) with dysfunction of blood coagulation.Method: A total of 230 patients with AAD hospitalized in General Hospital of Guangzhou Military Command from January 2014 to June 2018 were enrolled.All patients were divided into experimental group (n=43, with abnormal coagulation function) and control group (n=186, with comparatively normal coagulation function) according to clinical history and examination data.All patients received emergency surgical treatment after completed preoperative examinations and abnormal coagulation treatment strategy was guided by coagulation-related examination results in the laboratory.Patients with abnormal coagulation were preferred to use autologous aorta or artificial vascular patches for anastomotic coverage wrapping treatment.The clinical data of preoperative general conditions, operation datas, blood transfusion related indicators, and postoperative recovery between two groups was compared and analyzed.Result: All AAD patients completed surgical operation.Compared with control group, the incidence of abnormal liver function and coagulation-related indexes before operation was higher, the rate of total arch replacement was lower, the operation time was longer, perioperative concentrated red blood cells, fresh frozen plasma, platelets, and coagulation components such as prothrombin complex, recombinant human coagulation factor Ⅶ, and fibrinogen were infused larger, and the drainage volume was higher 24 hours after operation, ICU time was longer, the proportion of re-thoracotomy hemostasis, hemofiltration treatment, mediastinal infection, and hospital mortality were relatively higher in experimental group (all P<0.05).There was no significant difference in cardiopulmonary bypass time, aortic occlusion time, minimum temperature during operation and pulmonary infection rate after operation between two groups.Conclusion: There are many complications and high risk for AAD patients with abnormal coagulation function.Such patients should be given targeted drug and relatively simple surgical treatment and the effect of surgery is acceptable.
- type A aortic dissection /
- coagulation dysfunction /
- risk /
- strategy

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