Clinical Observation On47Cases Of Operation Strategy Of Stanford Type A Aortic Dissection On The Recent Curative Effect

Background and objectiveIn recent years, with the improvement of people’s living standard, there is an upward trend of hypertension, hyperlipidemia, arteriosclerosis disease incidence rate, incidence of ascending aortic dissection aneurysm is gradually increasing, and has become one of the common diseases in china. Statistics:acute dissecting aneurysm (10-29) annual incidence rate can reach/100million people.21%of the patients died before admission, patients died within48h after admission in68.2%hospitalized, shows a high mortality of aortic dissection (2). Dissection involving the ascending aorta and aortic arch in breach of the emergency operation should be performed to save lives. Foreign literature reports bulk operation treatment of aortic dissection mortality was9-33%. Through the different operation in our hospital in2009September-2013methods in September47cases of Stanford type A aortic dissection patients the short-term effect on clinical analysis, to study and improve the operation effect of patients with type A aortic dissection. Materials and methodsClinical data of patients in our hospital in2009September to2013September in type A aortic dissection operation in47cases. There were34male,13female; age36-75years, mean age51.4±8years; weight44-95kg, average weight of76.4±9.2kg, preoperative16row or320row spiral CT and bedside ultrasound diagnosed. All patients in the incidence of less than14d within48h after admission, or arrange operation. Operation using deep hypothermic low flow, selective cerebral perfusion. Part of the cases without cerebral perfusion, reason: arch disease complex, for the sake of clear operation field to shorten the cardiac arrest time; right axillary artery without intubation conditions or failed intubation; selection of femoral artery catheterization. The cases were divided into circulatory arrest after cerebral perfusion group and non cerebral perfusion group, patients in the two groups were observed and circulatory arrest time less than20minutes and more than30minutes of recent prognosis. The patients were divided into low temperature circulation arrest before anastomosis brachiocephalic vessels anastomosis of the left common carotid artery group and routine stop cycles, two groups were observed in patients with recent prognosis. Through statistical analysis, summed up the different operation strategies of short-term effect on patients with type A aortic dissection operation. Result1deep hypothermic circulatory arrest time less than20minutes, a cerebral perfusion group and non cerebral perfusion group in the extracorporeal circulation time, postoperative recovery time, postoperative ventilation support time, nervous system complications, severe pulmonary infection rate have little difference, no statistical difference.2deep hypothermic circulatory arrest time more than30minutes, a cerebral perfusion group and non cerebral perfusion group little difference in cardiopulmonary bypass time, no statistical difference. But the brain perfusion group awake time, surgery in the postoperative ventilation support time, nervous system complications, severe pulmonary infection rate is better than no cerebral perfusion group, there was significant difference.3to improve the operation strategy, low temperature of circulatory arrest before anastomosis of left common carotid artery group and routine circulatory arrest with brachiocephalic vessels in cardiopulmonary bypass time, postoperative awake time, nervous system complications and severe pulmonary infection rate difference, but no statistical difference; low temperature circulation arrest before anastomosis in left neck total artery group stop cycle time, operation in deep hypothermia after ventilation support time are better than those of conventional circulatory arrest with brachiocephalic vessels group, with statistical significance.ConclusionStop the cycle time in20minutes, with cerebral perfusion and no cerebral perfusion. No significant difference in patients with recent; circulatory arrest time more than30minutes of cerebral perfusion group efficacy is better than no cerebral perfusion group, there is statistical significance. Improvement of low temperature operation strategy in circulatory arrest before anastomosis of left common carotid artery during the operation with operation to co-ordinate arrangements for cooling, reducing the circulatory arrest during operation, so as to shorten the cardiac arrest time, shorten the deep hypothermic circulatory arrest effects on the body, do not affect the patient’s recovery, does not increase the incidence of neurologic and pulmonary complications recently, is conducive to the recovery of patients, is an effective operation strategy.