Merrill W H, Lee R B, Hammon J W, Frist W H, Stewart J R, Bender H W
Department of Cardiac and Thoracic Surgery, Vanderbilt University School of Medicine, Nashville, Tennessee.
Ann Surg. 1988 Jun;207(6):699-706. doi: 10.1097/00000658-198806000-00009.
Acute traumatic tear of the thoracic aorta is a severe injury with a high mortality rate. This condition requires expeditious evaluation and prompt surgical intervention in order to improve patient survival. The experience at the authors' institution from 1971 to 1987 includes 41 patients who sustained acute traumatic tear of the thoracic aorta and reached the hospital alive. The purpose of the study was to evaluate the surgical management of this injury with regards to mortality rate and the incidence of spinal cord injury. Five patients died from exsanguination before definitive repair could be undertaken. Thirty-six patients had repair of traumatic aortic tear in the area of the isthmus. Nine patients were operated upon with the clamp and sew technique, 20 patients had a heparin-bonded shunt placed, and seven patients were treated by repair with cardiopulmonary bypass. There were five operative deaths that were not related to the technique employed. Two patients without preoperative evidence of spinal cord injury developed paraparesis. No patient had postoperative paraplegia. Despite rapid transport, expeditious evaluation, and emergency thoracotomy, some patients die from exsanguination prior to definitive repair. Even with the provision of distal aortic perfusion during clamping, the risk of spinal cord injury is not eliminated.
胸主动脉急性创伤性撕裂是一种严重损伤，死亡率很高。这种情况需要迅速评估并及时进行手术干预，以提高患者生存率。作者所在机构在1971年至1987年期间的经验包括41例胸主动脉急性创伤性撕裂且存活到达医院的患者。本研究的目的是评估这种损伤的手术治疗在死亡率和脊髓损伤发生率方面的情况。5例患者在进行确定性修复之前死于失血过多。36例患者在峡部区域进行了创伤性主动脉撕裂修复。9例患者采用钳夹缝合技术进行手术，20例患者放置了肝素结合分流管，7例患者通过体外循环进行修复。有5例手术死亡与所采用的技术无关。2例术前无脊髓损伤证据的患者出现了截瘫。没有患者术后出现截瘫。尽管进行了快速转运、迅速评估和紧急开胸手术，但一些患者在确定性修复之前死于失血过多。即使在钳夹期间提供远端主动脉灌注，脊髓损伤的风险也无法消除。
