【作者】 赵光强；

【导师】 黄云超； 杨达宽；

【作者基本信息】 昆明医学院 ， 胸心血管外科， 2004， 硕士

【摘要】 目的：通过比较胸主动脉夹层动脉瘤腔内隔绝术治疗前后的心肝肾功能变化，探讨腔内隔绝术对心肝肾功能的影响。 方法：螺旋CT血管造影(CTA)、磁共振造影(MRA)、数字减影血管造影(DSA)确诊胸主动脉夹层动脉瘤。根据患者影像评估的具体情况，选择合适移植物。在DSA监视、全麻气管插管下，经股动脉将带膜支架置入12例胸主动脉夹层动脉瘤，进行腔内治疗。全自动生化分析仪和超声心动图仪分别进行手术前后心肝肾功能测定。 结果： 1．肾功能测定结果：术后48-72小时与术前肌酐、尿素均无显著性差异。术后一月肌酐、尿素下降明显，肾功能有一定程度改善，与术前和术后48-72小时比较有统计学意义(P＜0.05)。 2．肝功能测定结果：术后48-72小时血清总蛋白、白蛋白、球蛋白数值明显下降，与术前比较有统计学意义(P＜0.01)，术后一月血清蛋白又回复至术前水平。手术前后总胆红素、间接胆红素无显著性差别，但直接胆红素术后48-72小时明显增加(P＜0.05)，术后一月恢复至术前水平。手术前后谷丙转氨酶、谷草转氨酶均无明显变化。 3．心功能测定结果：术后左室射血分数EF较术前明显增加(P＜0.01)，左室收缩功能得到改善；术后24-48小时和术前比较，二尖瓣舒张早期血流峰值速度E峰和E／A值无显著性差别；术后三月E峰和E／A比值均有一定程度增加，与术后24-48小时和术前比较有显著性差异(P＜0.05)，术后三月左室舒张功能也得到一定改善。 昆明医学院研究生论文结论：带膜支架腔内隔绝术对胸主动脉夹层动脉瘤患者的心肝肾功能影响轻微。该技术是一种适合胸主动脉夹层动脉瘤，尤其是同时合并高龄及一定脏器功能不全患者的比较安全的微创治疗方法。更多还原

【Abstract】 To investigate the influence of endovascular graft exclusion(EVGE) by comparing the change of the function of heart ,liver and kidney before and after the EVGE of thoracic aortic dissection (TAD, Stanford B).Methods: Computed tomography angiography (CTA), magnetic resonance imaging (MRA)or digital subtraction angiography (DSA) were used as preoperative evaluation methods of thoracic aortic dissection aneurysm. According to the specific situation of patients, the suitable stent-grafts were selected. The stent-grafts were inserted from the femoral artery to exclude the tear of dissection of 12 cases, and all operations were performed by general anesthesia under DSA guidance. The function of heart, liver and kidney was measured before and after operation by using the automatic apparatus of serum biochemical analysis and echocardiography. Results.1. Kidney function measurement: There was no significant difference between the parameters of creatinine (Cr) and blood urea (BU) before and 48-72 hours after operation. Cr and BU significantly decreased one month after operation (P< 0. 05).There was a certain improve on the function of heart.2. Liver function measurement. 48-72 hours after operation, the serum contents of total protein, albumin, globulin decreased significantly and connect bilirubin , recovering the level of before operation one month after operation, increased significantly compared with those before operation. There was no significant change in the total bilirubin, unconnect bilirubin , ALT, AST, pre-and post operation. 3. Heart function measurement: EF increased significantly 24-48 hours after operation3compared with that of preoperation. No difference in peak of E and E/A24-48 hours after operation. Peak of E and E/A increased three months after operation too. Conclusion: EVGE has minimal influence on the function of heart, liver and kidney, and is a microinvasive theropy to treat TAD(Stanford B) with elder advanced and organ dyefunction.更多还原