标题：右房分流技术在Stanford A型主动脉夹层手术治疗中的应用

      作者：买买提艾力·艾则孜，郭永忠，张为民，阿依别克·乃比，叶尔买克·唐沙哈尔，刘筠，张总刚    (新疆维吾尔自治区人民医院心外科，新疆 乌鲁木齐 830001)

      卷次： 2018年29卷21期

      【摘要】 目的 探讨右房分流技术在Stanford A型主动脉夹层手术治疗中的临床经验及优势。方法 回顾性连续纳入2016年1月至2018年4月于新疆维吾尔自治区人民医院心外科手术治疗的204例Stanford A型主动脉夹层患者，其中行右房分流的患者120例(右房分流组)，未行右房分流的患者84例(右房未分流组)，比较两组患者术前基线资料、术中手术相关时间、出血量和输血量以及术后引流量、拔管时间和输血量的差异。结果 术前，两组患者的年龄、性别、合并高血压比例以及红细胞、血红蛋白、血小板比较差异均无统计学意义(P>0.05)；术中，右房分流组和右房未分流组患者的手术时间[(7.11±1.55) h vs (7.66±1.40) h]、体外循环转机时间[(178.90±42.41) min vs (203.90±52.05) min]、心肌阻断时间[(101.70±23.84) min vs (116.80±29.27) min]、选择性脑灌注时间[(21.93±11.27) min vs (28.04±5.03) min]、体外循环辅助时间 [(65.73±28.03) min vs (77.11±25.94) min]以及术中出血量 [(987.50±433.80) mL vs (1132±436.10) mL]比较，右房分流组均少于右房未分流组，差异均有统计学意义(P<0.05)；术后与右房未分流组相比，右房分流组输血液制品量(红细胞悬液、血浆量、血小板)和引流量(1 h、2 h、3 h、24 h、48 h、72 h)更少，且拔管时间更短[(7.18±1.49) d vs (13.08±3.04) d]，差异均有统计学意义(P<0.05)。结论 右房分流技术应用于Stanford A型主动脉夹层可有效缩短手术相关时间和拔管时间，减少血液制品用量及术后引流量，技术安全有效，值得临床推广应用。
      【关键词】 主动脉疾病；主动脉夹层；出血；止血；分流技术
      【中图分类号】 R654.2 【文献标识码】 A 【文章编号】 1003—6350（2018）21—2976—04

Application of right-atrium shunt in surgical treatment of Stanford type A aortic dissection.
MAIMAITIAILI Aizezi,GUO Yong-zhong, ZHANG Wei-min, AIBEK Nebi, ELMAIK Doshahar, LIU Jun, ZHANG Zong-gang. Department ofCardiac Surgery, People’s Hospital of Xinjiang Uygur Autonomous Region, Urumqi 830001, Xinjiang, CHINA
【Abstract】 Objective To investigate the experience and advantage of applying right-atrium distributary in theoperation of Standford type A aortic dissection. Methods A retrospective study was performed from January 2016 toApril 2018 in the Department of Cardiac Surgery, People’s Hospital of Xinjiang Uygur Autonomous Region, and 204 pa-tients who were diagnosed with Stanford type A aortic dissection and underwent surgery were enrolled, of which 120 cas-es applied right-atrium distributary (defined as right-atrium distributary group) and 84 cases did not apply the distribu-tary technique (defined as non-right-atrium distributary group). Preoperative baseline data, operation time, haemorrhagiaamount, blood transfusion and postoperative drainage were analyzed in the two groups. Results Preoperative baseline da-ta of the age, gender, hypertension ratio and the count of red blood cell, hemoglobin, white blood cell had no differencesbetween the two groups (P>0.05). The time of operation, cardiopulmonary bypass, aortic cross clamp, selective cerebralperfusion and circulatory arrest in the patients with right-atrium distributary were (7.11 ± 1.55) h, (178.90 ± 42.41) min,(101.70±23.84) min, (21.93±11.27) min and (65.73±28.03) min, which were significantly lower than (7.66±1.40) h,(203.90±52.05) min, (116.80±29.27) min, (28.04±5.03) min and (77.11±25.94) min in the patients who did not apply theshunt technique (P<0.05). In addition, the amount of intra-operative haemorrhagia in right-atrium distributary groupwere (987.50±433.80) mL, significantly less than (1 132±436.10) mL in non-right-atrium distributary group (P<0.05).After operation, compared with non-right-atrium distributary group, the right-atrium distributary group had less amountof blood transfusion and postoperative drainage (1 h, 2 h, 3 h, 24 h, 48 h, 72 h), as well as shorter extubation time (7.18±1.49) days vs (13.08 ± 3.04) days, and the differences was statistically significant (P<0.05). Conclusion Applyingright-atrium distributary in the operation of Standford type A aortic dissection can effectively shorten the time of opera-tion and extubation time, and reduce the amount of blood transfusion and postoperative drainage. Hence, the shunt tech-nique is safe and effective, and is worthy of clinical use.
      【Key words】 Aortic diseases; Aortic dissection; Hemorrhage; Hemostasis; Shunt technique·论 著·doi:10.3969/j.issn.1003-6350.2018.21.005