Department of Cardiovascular Surgery, General Hospital of Ningxia Medical University, Yinchuan 750004, China.
Department of Pediatrics, General Hospital of Ningxia Medical University, Yinchuan 750004, China.
Int J Clin Pract. 2023 Jan 10;2023:4191277. doi: 10.1155/2023/4191277. eCollection 2023.
To summarize the experience of the postoperative intensive care treatment of Stanford type A aortic dissection (STAAD) following Sun's procedure.
A total of 124 patients with STAAD who underwent Sun's procedure from January 2014 to December 2021 at the General Hospital of Ningxia Medical University were retrospectively analyzed. All patients were admitted to the cardiac surgery intensive care unit (ICU) after surgery. According to the perioperative characteristics of the patients with STAAD, intensive care treatment was given to actively prevent the occurrence of postoperative complications.
In all the cases enrolled in this study, the causes of aortic dissection comprised hypertension (105 cases), trauma (six cases), Marfan's syndrome (six cases), and aorto-arteritis (seven cases). The history of past illnesses comprised hypertension (105 cases), coronary disease (25 cases), diabetes mellitus (16 cases), and chronic obstructive pulmonary disease (six cases). There were some preoperative complications, such as cardiac insufficiency, acute liver insufficiency, acute renal insufficiency, pleural effusion, pericardial effusion, pulmonary infection, lower limb ischemia, mesenteric arterial embolism, and digestive tract hemorrhage. The average cardiopulmonary bypass time was 186 ± 32.1 min, the aortic clamp time was 74 ± 12.8 min, the deep hypothermic circulatory arrest time was 21 ± 2.6 min, and the mechanical ventilation time was 34 ± 2.8 h. The average ICU and hospital residence times were 7 ± 1.6 days and 12 ± 3.6 days, respectively. Postoperative complications comprised hypoxemia (34 cases), pulmonary infections (22 cases), tracheostomy (four cases), cerebral hemorrhage (four cases), cerebral infarction (four cases), transient delirium (eight cases), secondary thoracotomies due to bleeding (two cases), alimentary tract hemorrhage (eight cases), and acute renal insufficiency (38 cases). There was no occurrence of hoarseness or chylothorax. There were 15 cases of death, and the total mortality rate was 12.1%. In four cases, the cause of death was one postoperative complication (3.2%), and in 11 cases, the cause of death was multiple postoperative complications (8.9%). The other patients were discharged from the hospital with a good prognosis for full recovery.
Postoperative intensive care treatment was an important part of the successful surgical treatment of STAAD.
总结孙氏手术治疗 Stanford 型 A 型主动脉夹层（Stanford type A aortic dissection，STAAD）术后重症监护治疗的经验。
回顾性分析 2014 年 1 月至 2021 年 12 月宁夏医科大学总医院心外科采用孙氏手术治疗的 124 例 STAAD 患者的临床资料。所有患者术后均入住心脏外科重症监护病房（intensive care unit，ICU）。根据 STAAD 患者围手术期特点，积极预防术后并发症的发生，给予重症监护治疗。
本研究纳入的所有病例中，主动脉夹层的病因包括高血压（105 例）、外伤（6 例）、马凡综合征（6 例）、主动脉炎（7 例）。既往病史包括高血压（105 例）、冠心病（25 例）、糖尿病（16 例）、慢性阻塞性肺疾病（6 例）。术前存在心功能不全、急性肝功能不全、急性肾功能不全、胸腔积液、心包积液、肺部感染、下肢缺血、肠系膜动脉栓塞、消化道出血等并发症。体外循环时间平均为 186±32.1min，主动脉阻断时间为 74±12.8min，深低温停循环时间为 21±2.6min，机械通气时间为 34±2.8h。患者 ICU 及住院时间分别为 7±1.6d 和 12±3.6d。术后并发症包括低氧血症（34 例）、肺部感染（22 例）、气管切开（4 例）、脑出血（4 例）、脑梗死（4 例）、一过性谵妄（8 例）、因出血再次开胸（2 例）、消化道出血（8 例）、急性肾功能不全（38 例）。无声音嘶哑或乳糜胸发生。死亡 15 例，总死亡率为 12.1%。其中 4 例死亡原因为 1 种术后并发症（3.2%），11 例死亡原因为多种术后并发症（8.9%）。其余患者均康复出院，预后良好。
术后重症监护治疗是孙氏手术成功治疗 STAAD 的重要组成部分。
