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34例主动脉瘤的体外循环转流体会

时间:2017-09-15 17:00:12 来源: 代写硕士论文

                    作者:木拉提,刁新民,霍强,艾斯卡尔,阿不拉江

【摘要】  目的结合34例主动脉瘤及夹层动脉瘤的外科治疗经验,探讨此病的手术技术及体外灌注方法。方法2001年至2005年间手术治疗主动脉瘤34例,其中马方综合征20例,夹层动脉瘤DeBakey I型2例,DeBakey II型2例,动脉硬化性主动脉瘤4例,动脉硬化性主动脉瘤合并夹层DeBakey III型1例,主动脉瓣关闭不全合并升主动脉扩张5例。行Bentall手术20例,Wheat手术4例,Bentall手术同期行半弓置换1例,升主动脉全弓置换及降主动脉内支架置入1例, David手术1例,Cabrol手术1例,升主动脉部分纵行切除加折叠缝合同期行主动脉瓣置换手术5例,行腹主动脉人工血管置换术1例。采用中度低温体外循环32例,深低温停循环(DHCA)和上腔静脉逆灌(RCP)2例。结果全组无手术死亡和住院死亡。1例术后发生低心排。结论采用不同的手术治疗方法和体外循环技术治疗主动脉瘤可以取得良好的效果。

【关键词】  主动脉瘤;体外循环;心脏外科手术

  Extracorporeal Circulation of 34 Cases of Aortic Aneurysm 

  Abstract: OBJECTIVETo summarize our experience of 34 cases of aortic aneurysm and dissecting aneurysm,To explore the skills of the operation and cardiopulmonary bypass techniques . METHODSThirty-four patients with aortic aneurysm underwent surgical treatment in our department from 2001 to 2005,20 cases were Marfan syndrome,DeBakey typeⅠ2 cases,type Ⅱ 2 cases,arteriosclerosis aortic aneurysm 4 cases,arteriosclerosis aortic aneurysm complicated DeBakey type Ⅲ1 cases, aortic valve incompetence associated with ascending aortic dilation 5 cases. Bentall operation were performed in 20 patients,4 Wheat operations,Bentall operation concomitant procedure ascending and hemiarch grafting in 1case,procedure ascending and complete arch grafting in 1case,1 David operation,1 Cabrol operation,ascending aorta cutting concomitant procedure AVR in 5 cases,1 graft replacement of aorta abdominalis .Moderate hypothermic circulatory arrest in 32 cases,Deep hypothermic circulatory arrest (DHCA) combined with retrograde cerebral perfusion(RCP) in 2 cases. RESULTSAll patients survived.Postoperation complicated low cardiac output syndrome in one case. CONCLUSIONAdopted varied methods of surgical treatment and the technique of extracorporeal circulation for the aortic aneurysm can obtain a satisfactory result.

  Key words:Aortic aneurysm;Extracorporeal circulation;Cardiac surgical procedures 

  新疆医科大学第一附属医院心脏外科在2001年至2005年间共手术治疗34例主动脉瘤患者,现总结经验,报道如下。

  1资料与方法 

  1.1临床资料

  本组中男29例,女5例,年龄34~ 66岁。其中马方综合征20例,夹层动脉瘤DeBakeyI型2例,DeBakey II型2例,动脉硬化性主动脉瘤4例,动脉硬化性主动脉瘤合并夹层动脉瘤DeBakey III型1例,主动脉瓣关闭不全合并升主动脉扩张5例。既往有高血压病史者21例,肾功能不全6例,糖尿病5例。术前经MRI明确诊断,心脏超声检查主动脉瓣关闭不全30例,左室射血分数(LVEF)<0.5者11例。均采用择期手术。

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