内膜片旷置法主动脉根部成形在Standford A型夹层中的应用

摘要

目的 探讨内膜片旷置法主动脉根部成形在Standford A型夹层中的的应用效果.方法 选择2015年6月至2017年7月于郑州市第七人民医院心外科收治的Standford A型夹层患者13例为研究对象,术前完成相关检查,入组患者均采用内膜片旷置法主动脉根部成形治疗,采用彩色超声心动图测定患者手术前后左心室舒张末期内径(LVEDD)、左心室收缩末期内径(LVESD)及左心室射血分数(LVEF)水平,术后对患者进行7~17个月随访,记录患者主动脉返流程度,分析内膜片旷置法主动脉根部成形在Standford A型夹层中的应用效果.结果 13例患者均取得手术成功,体外循环时间(182.31±23.85)min,主动脉阻断时间(132.94±30.85)min,输血量(1020.31±36.93)m L,住院时间(9.32±1.46)d对照组均高于研究组(P＜0.05).研究组的LVEDD、LVESD分别为(51.23±5.06)mm、(41.23±5.93)mm,均低于对照组(P＜0.05);研究组的LVEF水平为(53.31±4.98)%,显著高于对照组(P＜0.05).研究组术后无主动脉返流发生率高于对照组(P＜0.05);研究组术后主动脉返流微量、少量、中量发生率低于对照组(P＜0.05).结论 将内膜片旷置法主动脉根部成形用于Standford A型夹层中患者的效果理想,有助于改善患者心功能,降低返流程度,值得推广应用.%To investigate the effect of aortic root plasty by intimal flap exclusion on Standford type-A dissection. Methods The patients with Standford type-A dissection (n=13) were chosen into study group, and patients received modified "sandwich" proximal aortic root plasty (n=13) were chosen into control group from Department of Cardiac Surgery of Zhengzhou Municipal Seventh People’s Hospital from June 2015 to July 2017. All patients were given relative examinations before admission, and underwent aortic root plasty by intimal flap exclusion after hospitalization. The levels of left ventricular end-diastolic inner diameter (LVEDd), left ventricular end-systolic diameter (LVESd) and left ventricular ejection fraction (LVEF) were detected by using color echocardiography before and after the operation. The patients were followed up for from 7 months to 17 months, and degree of aortic regurgitation was recorded. The application effect of aortic root plasty by intimal flap exclusion was analyzed in treatment of Standford type-A dissection. Results The operation was success in study group, and time of cardiopulmonary bypass (182.31±23.85) min, time of aorta blocking (132.94±30.85) min, blood transfusion volume (1020.31±36.93) m L and length of hospital stay (9.32±1.46) d were all higher in control group than those in study group (P<0.05). The levels of LVEDd (51.23±5.06) mm and LVESd (41.23±5.93) mm were all lower in study group than those in control group (P<0.05). The level of LVEF was (53.31±4.98)% in study group, which was significantly higher than that in control group (P<0.05). The incidence of postoperation non-aortic regurgitation was higher in study group than that in control group (P<0.05). The incidences of mild, little and medium volume of aortic regurgitation were lower in study group than those in control group (P<0.05). Conclusion The efficacy of aortic root plasty by intimal flap exclusion is ideal in patients with Standford type-A dissection, and it is good for improve patients’ heart function, reduce regurgitation degree and worth to be popularized and applied.