预置心包包裹法在A型主动脉夹层全弓置换术中的应用效果分析

目的 观察 A型主动脉夹层（AAD）全弓置换术预置心包包裹止血效果。方法 回顾性分析2021年1月至2021年11月间诊断为AAD并行采用预置包裹止血法行主动脉全弓置换手术患者的临床资料，共35例入选，并选择我科同期传统方法行全弓置换的35例AAD患者作为对照组。观察预置包裹组和对照组手术中情况：包括术中情况（主动脉根部处理方法，手术、心脏停搏及体外循环时间，术中用血量）、术后凝血功能{术后早期凝血功能对比，包括术后第一日血小板计数、凝血酶原时间，纤维蛋白原（Fib）、K时间、最大血块强度}）、两组术后恢复情况，包括术后24 h引流量和用血量，再次开胸止血、机械通气时间、血滤治疗例数， 入住ICU时间。结果 与对照组比较，预置包裹组体外循环时间、手术时间更短，术中使用红细胞量更少（P均＜0.05）。与对照组比较，预置包裹组在术后早期血小板计数、纤维蛋白原浓度、最大血块强度更高，凝血酶原时间及K时间更短（P均＜0.05）。两组的再次开胸止血例数无明显差异，但预置包裹组术后24 h的引流量少于对照组（P＜0.05）。结论 AAD全弓置换术预置心包包裹止血能减少手术时间、降低围术期出血量、保护患者凝血功能、有助于患者术后恢复，可以作为临床止血方法。

Analysis of the effect of pre-arranged pericardial wrapping in total arch replacement for type A aortic dissection

Objective To observe the hemostatic effect of pre-arranged pericardial wrap in total arch replacement for type A aortic dissection (AAD). Methods From January 2021 to November 2021, 35 patients who were diagnosed with AAD by computer scanning angiography and underwent total arch replacement surgery and underwent pre-arranged pericardial wrapping hemostasis in our hospital were selected as the pre-packaged group, and the same period 35 AAD patients who underwent total arch replacement without pre-arranged pericardial wrapping hemostasis were selected as the control group. The intraoperative conditions of the pre-packaged group and the control group were observed: including the surgical method of the aortic root, the operation time, cardiopulmonary bypass time, cardiac arrest time, blood transfusion during surgery. The comparison of early postoperative blood coagulation function between the pre-packaged group and the control group: including platelet count (PLT), international normalized ratio (INR), prothrombin time (PT), fibrinogen (Fib), K time (K), maximum clot strength (MA) on the first postoperative day. The comparison of the recovery after sugery between the pre-packaged group and the control group: included drainage volume 24 h after surgery, blood transfusion 24 h after surgery, second thoracotomy for hemostasis, mechanical ventilation time, number of hemofiltration cases, and ICU time. Results Compared with the control group, the pre-packaged group had shorter cardiopulmonary bypass time and operation time, and less red blood cells were used during the operation (P < 0.05). Compared with the control group, the pre-packaged group had higher platelet count, fibrinogen concentration, maximum clot strength, and shorter prothrombin time and K time in the early postoperative period (P < 0.05). There was no significant difference in the number of cases of second thoracotomy for hemostasis between the two groups, but the drainage volume in the pre-packaged group was less than that in the control group at 24 hours after surgery (P < 0.05). Conclusion Pre-arranged pericardial wrap for hemostasis in AAD total arch replacement can reduce operation time, reduce perioperative blood loss, protect the coagulation function of patients, and help patients recover after surgery. Pre-arranged pericardial wrap could be available hemostasis method in AAD total arch replacement.