胸主动脉腔内修复术后急性复杂B型主动脉夹层的早期灌注不良、缺血再灌注损伤及呼吸衰竭
Early malperfusion, ischemia reperfusion injury, and respiratory failure in acute complicated type B aortic dissection after thoracic endovascular repair.
作者信息
Xiong Jiang, Zhang Minhong, Guo Wei, Liu Xiaoping, Yin Tai, Jia Xin, Zhang Hongpeng, Xu Yongle, Wang Lijun
机构信息
Departments of Vascular Surgery, Clinical Division of Surgery, Chinese PLA General Hospital, Beijing, China.
出版信息
J Cardiothorac Surg. 2013 Jan 23;8:17. doi: 10.1186/1749-8090-8-17.
BACKGROUND
The aim of this study was to determine the early mortality and major complications of acute complicated type B aortic dissection (ACBD) after thoracic endovascular aortic repair (TEVAR).
METHODS
Twenty-six consecutive patients with ACBD who underwent TEVAR were included. Clinical indications before TEVAR and in-hospital mortality and major complications after TEVAR were analyzed and compared with similar reports.
RESULTS
TEVAR was technically successful in all cases. In-hospital mortality occurred in four patients (15%), and major complications occurred in an additional four patients (15%). Three of the four (75%) of the deaths were associated with malperfusion and ischemia reperfusion injury (IRI), and 3/4 (75%) of the major complications were caused by respiratory failure (RF).
CONCLUSIONS
In-hospital mortality associated strongly with severe end-organ malperfusion and IRI, while major complications associated with RF, during TEVAR. Our results indicate that malperfusion, IRI and respiratory failure during TEVAR should be carefully monitored and aggressively treated.
背景
本研究旨在确定胸主动脉腔内修复术（TEVAR）治疗急性复杂性B型主动脉夹层（ACBD）后的早期死亡率和主要并发症。
方法
纳入连续26例行TEVAR治疗的ACBD患者。分析TEVAR术前的临床指征以及TEVAR术后的院内死亡率和主要并发症，并与类似报道进行比较。
结果
所有病例TEVAR技术均成功。4例患者（15%）发生院内死亡，另有4例患者（15%）发生主要并发症。4例死亡患者中有3例（75%）与灌注不良和缺血再灌注损伤（IRI）相关，4例主要并发症中有3例（75%）由呼吸衰竭（RF）引起。
结论
TEVAR期间，院内死亡与严重的终末器官灌注不良和IRI密切相关，而主要并发症与RF相关。我们的结果表明，TEVAR期间的灌注不良、IRI和呼吸衰竭应予以密切监测并积极治疗。
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