DavidⅠ与Bentall术用于急性主动脉夹层的单中心疗效分析

doi:10.3969/j.issn.1004-583X.2024.05.006

摘要/Abstract

摘要：

目的比较单中心DavidⅠ与Bentall手术用于急性主动脉夹层的疗效。方法选取2020年1月至2022年12月于郑州大学第一附属医院心血管外科住院治疗的急性主动脉夹层患者28例,按照手术方法分为DavidⅠ组(n=13)和Bentall(n=15),DavidⅠ组采用DavidⅠ手术,Bentall组采用Bentall手术。随访1年,比较2组围术期相关指标、心脏指标、并发症。结果与Bentall组比较,DavidⅠ组手术时间、转机时间、主动脉阻断时间更长(P<0.05)。2组术中出血量、术后24 h引流量、呼吸机辅助时间、重症监护病房停留时间、住院时间差异均无统计学意义(P>0.05)。2组术前和术后1年左心室射血分数、升主动脉最大内径、左心室舒张末期内径差异均无统计学意义(P>0.05);与术前比较,DavidⅠ组术后1年左心室射血分数降低(P<0.05),2组术后1年升主动脉最大内径、左心室舒张末期内径均降低(P<0.05)。2组并发症发生率(46.1% vs 46.7%)差异无统计学意义(P>0.05)。结论 DavidⅠ与Bentall手术应用于急性主动脉夹层治疗的早期指标,术后生存率、瓣膜相关并发症等无明显差异。Bentall手术的手术时间、转机时间、主动脉阻断时间更短。

关键词: 主动脉夹层, DavidⅠ手术, Bentall手术, 疗效

Abstract:

Objective A single-center analysis of the efficacy of David I versus Bentall procedure for acute aortic dissection was conducted. Methods A total of 28 patients with acute aortic dissection hospitalized in the Department of Cardiovascular Surgery, the First Affiliated Hospital of Zhengzhou University from January 2020 to December 2022 were enrolled. According to the surgical methods, they were divided into David I group (n=13, received David I procedure ) and Bentall group (n=15, received Bentall’s procedure). After 1 year of follow-up, the inter-group perioperative indexes, cardiac indexes and complications were assessed. Results The operation time, transfer time and aortic occlusion time were significantly longer in David I group versus Bentall group (P<0.05). There were no significant differences in intraoperative blood loss, 24 h postoperative drainage volume, ventilator-assisted time, intensive care unit stay time, and hospitalization time in David I group versus Bentall group (P>0.05). There was no significant inter-group difference in left ventricular ejection fraction (LVEF), maximum diameter of ascending aorta and left ventricular end-diastolic diameter (LVDD) before operation and on year 1 of operation (P>0.05). LVEF in David I group was significantly decreased on year 1 of operation than that before operation (P<0.05), and maximum diameter of ascending aorta and LVDD were significantly decreased on year 1 of operation in the both groups than those before operation (P<0.05). There was no inter-group significant difference in the incidence of complications (46.1% vs 46.7%, P>0.05). Conclusion There was no significant difference in postoperative survival rate and valvular complications between Bentall and David Ⅰ procedure in the treatment of acute aortic dissection. The Bentall procedure has a shorter operating time, transit time, and aortic occlusion time.

Key words: aortic dissection, David Ⅰ surgery, Bentall surgery, curative effect

中图分类号:

R543.1

刘洋, 马宁, 张伟华. DavidⅠ与Bentall术用于急性主动脉夹层的单中心疗效分析[J]. 临床荟萃, 2024, 39(5): 420-425.

Liu Yang, Ma Ning, Zhang Weihua. Single-center analysis of David I versus Bentall's procedure for acute aortic dissection[J]. Clinical Focus, 2024, 39(5): 420-425.

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链接本文: https://huicui.hebmu.edu.cn/CN/10.3969/j.issn.1004-583X.2024.05.006

https://huicui.hebmu.edu.cn/CN/Y2024/V39/I5/420

图/表 7

参考文献 19

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组别		例数	年龄 (岁)			性别[例(%)]				体质量指数 (kg/m²)			破口位置[例(%)]
组别		例数	年龄 (岁)			男		女		体质量指数 (kg/m²)			升主动脉		主动脉弓		降主动脉
DavidⅠ组		13	43.85±8.61			13(100.0)		0		27.30±3.82			10(76.9)		3(23.1)		0
Bentall组		15	41.87±13.02			12(80.0)		3(20.0)		25.55±3.99			12(80.0)		1(6.7)		2(13.3)
t/χ²值			0.466			2.912				1.177			3.055
P值			0.645			0.088				0.25			0.217
组别	主动脉反流程度[例(%)]						糖尿病 [例(%)]		高血压 [例(%)]		脑梗死 [例(%)]	心肌缺血 [例(%)]		肠道缺血 [例(%)]		吸烟史 [例(%)]		饮酒史 [例(%)]
组别	1级			2级	3级		糖尿病 [例(%)]		高血压 [例(%)]		脑梗死 [例(%)]	心肌缺血 [例(%)]		肠道缺血 [例(%)]		吸烟史 [例(%)]		饮酒史 [例(%)]
DavidⅠ组	4(30.8)			6(46.2)	3(23.0)		0		6(46.1)		2(15.4)	1(7.7)		0		6(46.2)		7(53.9)
Bentall组	3(20.0)			3(20.0)	9(60.0)		2(13.3)		5(33.3)		5(33.3)	1(6.7)		1(6.7)		4(26.7)		5(33.3)
t/χ²值	4.021						1.867		0.48		1.197	0.011		0.899		1.152		1.197
P值	0.134						0.172		0.488		0.274	0.916		0.343		0.283		0.274

组别		例数	年龄 (岁)			性别[例(%)]				体质量指数 (kg/m²)			破口位置[例(%)]
组别		例数	年龄 (岁)			男		女		体质量指数 (kg/m²)			升主动脉		主动脉弓		降主动脉
DavidⅠ组		13	43.85±8.61			13(100.0)		0		27.30±3.82			10(76.9)		3(23.1)		0
Bentall组		15	41.87±13.02			12(80.0)		3(20.0)		25.55±3.99			12(80.0)		1(6.7)		2(13.3)
t/χ²值			0.466			2.912				1.177			3.055
P值			0.645			0.088				0.25			0.217
组别	主动脉反流程度[例(%)]						糖尿病 [例(%)]		高血压 [例(%)]		脑梗死 [例(%)]	心肌缺血 [例(%)]		肠道缺血 [例(%)]		吸烟史 [例(%)]		饮酒史 [例(%)]
组别	1级			2级	3级		糖尿病 [例(%)]		高血压 [例(%)]		脑梗死 [例(%)]	心肌缺血 [例(%)]		肠道缺血 [例(%)]		吸烟史 [例(%)]		饮酒史 [例(%)]
DavidⅠ组	4(30.8)			6(46.2)	3(23.0)		0		6(46.1)		2(15.4)	1(7.7)		0		6(46.2)		7(53.9)
Bentall组	3(20.0)			3(20.0)	9(60.0)		2(13.3)		5(33.3)		5(33.3)	1(6.7)		1(6.7)		4(26.7)		5(33.3)
t/χ²值	4.021						1.867		0.48		1.197	0.011		0.899		1.152		1.197
P值	0.134						0.172		0.488		0.274	0.916		0.343		0.283		0.274

组别	例数	手术时间 (min)	转机时间 (min)	主动脉阻断时间(min)	术中出血量 (ml)	术后24 h 引流量(ml)	呼吸机辅助时间(h)	ICU停留时间 (h)	住院时间 (d)
DavidⅠ组	13	506.38±65.47	241.62±48.55	197.15±46.51	607.69±394.68	694.62±289.73	90.27±40.68	109.00±54.03	18.46±10.13
Bentall组	15	438.53±95.87	190.27±47.86	131.60±34.80	600.00±742.58	645.33±299.16	76.67±34.73	84.33±41.74	13.14±4.87
t值		2.151	2.812	4.258	0.048	0.441	0.960	1.358	1.814
P值		0.041	0.009	<0.01	0.962	0.663	0.346	0.186	0.081

组别	例数	手术时间 (min)	转机时间 (min)	主动脉阻断时间(min)	术中出血量 (ml)	术后24 h 引流量(ml)	呼吸机辅助时间(h)	ICU停留时间 (h)	住院时间 (d)
DavidⅠ组	13	506.38±65.47	241.62±48.55	197.15±46.51	607.69±394.68	694.62±289.73	90.27±40.68	109.00±54.03	18.46±10.13
Bentall组	15	438.53±95.87	190.27±47.86	131.60±34.80	600.00±742.58	645.33±299.16	76.67±34.73	84.33±41.74	13.14±4.87
t值		2.151	2.812	4.258	0.048	0.441	0.960	1.358	1.814
P值		0.041	0.009	<0.01	0.962	0.663	0.346	0.186	0.081

组别	例数	LVEF(%)		升主动脉最大内径(mm)		LVDD(mm)
组别	例数	术前	术后1年	术前	术后1年	术前	术后1年
DavidⅠ组	13	61.54±4.18	55.23±10.41^*	48.00±6.84	28.92±1.32^*	55.23±5.53	48.31±3.23^*
Bentall组	15	59.87±3.64	58.77±6.53	52.21±8.46	28.54±2.63	57.50±7.98	48.38±6.01^*
t值		1.131	-1.092	-1.434	0.475	-0.860	-0.039
P值		0.268	0.285	0.164	0.639	0.397	0.969