| 摘要: |
| 目的 观察预置心包包裹法在A型主动脉夹层（AAD）全弓置换术中的止血效果。方法 回顾性分析我院2021年1月至11月诊断为AAD并采用预置心包包裹法行主动脉全弓置换术的35例患者资料，以同期采用传统方法行全弓置换的35例AAD患者为对照。观察两组患者的术中情况（主动脉根部处理方式、心脏停搏时间、体外循环时间、手术时间、术中红细胞使用量）、术后早期凝血功能（术后1 d血小板计数、凝血酶原时间、纤维蛋白原浓度、K时间、最大血块强度）及术后恢复情况（术后24 h引流量、再次开胸止血情况、机械通气时间、血液净化治疗情况、入住ICU时间）。结果 两组间主动脉根部处理方式、心脏停搏时间、再次开胸止血、机械通气时间、血液净化治疗、入住ICU时间的差异均无统计学意义（P均＞0.05）。预置包裹组的体外循环时间、手术时间短于对照组，术中红细胞使用量少于对照组（P均＜0.05）。预置包裹组的术后1 d血小板计数、纤维蛋白原浓度、最大血块强度高于对照组，凝血酶原时间及K时间短于对照组（P均＜0.05）。预置包裹组术后24 h引流量少于对照组（P＜0.05）。结论 AAD全弓置换术预置心包包裹法能减少手术时间、降低围手术期出血量、保护患者凝血功能，有助于患者术后恢复，可以作为临床止血方法。 |
| 关键词: A型主动脉夹层 全弓置换术 心包包裹 止血 |
| DOI：10.16781/j.CN31-2187/R.20220416 |
| 投稿时间：2022-05-16修订日期：2022-07-29 |
| 基金项目:军队临床高新技术重大项目（2010gxjs031），广东省医学科学技术研究基金（C2022135）. |
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| Application of pre-arranged pericardial wrapping in total arch replacement for type A aortic dissection |
| LUO Lin,YAN Tao,LIN Xi,ZHANG Ben,OUYANG Yaoming,ZHANG Weida,WANG Xianyue* |
(Department of Cardiovascular Surgery, General Hospital of Southern Theater Command of PLA, Guangzhou 510010, Guangdong, China
*Corresponding author) |
| Abstract: |
| Objective To observe the hemostatic effect of pre-arranged pericardial wrapping in total arch replacement for type A aortic dissection (AAD). Methods The data of 35 patients who were diagnosed as AAD and underwent total arch replacement with pre-arranged pericardial wrapping hemostasis in our hospital from Jan. to Nov. 2021 were retrospectively analyzed. Thirty-five AAD patients who underwent total arch replacement with traditional hemostatic methods in the same period were selected as controls. The intraoperative conditions (including the aortic root treatment, cardiac arrest time, cardiopulmonary bypass time, operation time, and blood transfusion during surgery), early postoperative blood coagulation function (including the platelet count, prothrombin time, fibrinogen concentration, K time, and maximum clot strength 1 d after operation), and postoperative recovery (including the drainage volume 24 h after operation, the second thoracotomy for hemostasis, mechanical ventilation time, hemofiltration, and intensive care unit［ICU］ admission time) of the pre-packaged group and the control group were observed. Results There were no significant differences in the aortic root treatment, cardiac arrest time, the second thoracotomy for hemostasis, mechanical ventilation time, hemofiltration, or ICU admission time between the 2 groups (all P＞0.05). Compared with the control group, the pre-packaged group had shorter cardiopulmonary bypass time and operation time, and less blood transfusion during the operation (all P＜0.05). Compared with the control group, the pre-packaged group had higher platelet count, fibrinogen concentration, maximum clot strength, and shorter prothrombin time and K time 1 d after operation (all P＜0.05). The drainage volume 24 h after operation in the pre-packaged group was less than that in the control group (P＜0.05). Conclusion Pre-arranged pericardial wrapping for hemostasis in AAD total arch replacement can reduce operation time and perioperative blood loss, protect the coagulation function of patients, and help patients recover after surgery, so it can be used as a clinical hemostasis method. |
| Key words: type A aortic dissection total arch replacement pericardial wrapping hemostasis |
