Department of Cardiovascular Surgery, The Affiliated Hospital of QingDao University, QingDao, China; Department of Cardiology, The Affiliated Cardiovascular Hospital of QingDao University, QingDao, China.
Department of Operation Room, The Affiliated Hospital of QingDao University, QingDao, China.
Heart Lung Circ. 2020 Aug;29(8):1203-1209. doi: 10.1016/j.hlc.2019.11.020. Epub 2019 Dec 27.
The aim of this study was to investigate the effect of the modified extracorporeal circulation perfusion method during surgery for acute Stanford type A aortic dissection in patients who underwent stented elephant trunk implantation and arch replacement.
A total of 69 patients with acute Stanford type A aortic dissection who underwent stented elephant trunk implantation and arch replacement were retrospectively analysed from 2017 to 2018. According to the perfusion method of extracorporeal circulation, patients were divided into a routine perfusion (RP) group and a modified perfusion (MP) group. Clinical data were collected, including the time of extracorporeal circulation and deep hypothermic circulatory arrest, incidence of acute kidney injury and neurological complications, and comparisons between the two groups were conducted by using independent sample t-tests for normally distributed qualitative data, the Mann-Whitney U-test for skewed qualitative data, and the chi square test or Fisher's exact test for categorical data.
There were 55 (80%) males and 14 (20%) females in the entire cohort, and the mean ± standard deviation age was 50.4±9.0 years. A total of 53 (77%) patients were included in the RP group, and 16 (23%) were included in the MP group. Patients in the MP group were older (55.5±7.8 vs 48.8±8.9 years), and the difference was significant (p=0.008). Compared with the RP group, the time of extracorporeal circulation (218.0 [44.7] vs 246.0 [58.0] min; p=0.005) and deep hypothermic circulatory arrest (4.0 [2.0] vs 25.0 [10.0] min; p<0.001) was shorter, and the incidence of postoperative acute kidney injury (n=6 [37.5%] vs n=36 [67.9%]; p=0.029) was lower in the MP group; the differences were significant. Six (6) patients died in the RP group; no patients died in the MP group. The total in-hospital mortality rate was 8.7%.
The modified extracorporeal circulation perfusion method is feasible, with satisfactory results.
本研究旨在探讨改良体外循环灌注方法在急性 Stanford 型 A 主动脉夹层Stanford 型 A 主动脉夹层患者行支架象鼻植入和弓部置换术中的应用效果。
回顾性分析 2017 年至 2018 年期间行支架象鼻植入和弓部置换术的 69 例急性 Stanford 型 A 主动脉夹层患者的临床资料。根据体外循环灌注方法，将患者分为常规灌注（RP）组和改良灌注（MP）组。收集患者的临床资料，包括体外循环和深低温停循环时间、急性肾损伤和神经系统并发症的发生率，并采用独立样本 t 检验比较正态分布的定性资料，采用 Maan-Whitney U 检验比较偏态分布的定性资料，采用卡方检验或 Fisher 确切概率法比较分类资料。
全队列共 55 例（80%）男性和 14 例（20%）女性，平均年龄为 50.4±9.0 岁。其中 RP 组 53 例（77%），MP 组 16 例（23%）。MP 组患者年龄较大（55.5±7.8 岁 vs 48.8±8.9 岁），差异有统计学意义（p=0.008）。与 RP 组相比，MP 组体外循环时间（218.0[44.7]min vs 246.0[58.0]min；p=0.005）和深低温停循环时间（4.0[2.0]min vs 25.0[10.0]min；p<0.001）更短，术后急性肾损伤发生率（n=6[37.5%] vs n=36[67.9%]；p=0.029）更低，差异均有统计学意义。RP 组 6 例（6%）患者死亡，MP 组无患者死亡。总住院死亡率为 8.7%。
改良体外循环灌注方法是可行的，效果满意。
