COVID-19疫情期间急性主动脉夹层手术湖北省多中心管理经验总结及建议

Objective To explore the appropriate treatment options for patients with acute aortic dissection during the COVID-19 epidemic. Methods From January 16 to February 26, 2020, a total of 37 acute aortic dissection surgeries were completed in multiple cardiac and great vessel centers in Hubei Province, including 18 open surgeries for Stanford type A aortic dissection and 19 interventional surgeries for Stanford type B aortic dissection. The surgical methods for acute Stanford type A aortic dissection included 10 cases (55.55%) of Stanford ascending aorta replacement and 7 cases (38.89%) of Bentall surgery; 14 cases (77.8%) of total arch replacement + stent elephant trunk surgery. Nineteen cases of acute Stanford type B aortic dissection underwent endovascular exclusion of thoracic aortic stent-grafts, and 2 cases simultaneously adopted the chimney technique for the left subclavian artery. Results There were no deaths within 30 days of hospitalization in this group. Preoperative nucleic acid testing excluded 7 cases of novel coronavirus infection, and 3 suspected cases underwent emergency surgery. Most surgeries (62.2%, 23/37) adopted three-level protection. The virus nucleic acid tests for 11 patients after aortic dissection surgery were all negative, and there has been no infection of medical staff and no cross-infection of patients so far. Conclusion During the epidemic, it is necessary to carefully identify whether patients with acute aortic dissection are complicated with COVID-19 before surgery. The treatment principle of "giving priority to the prevention and control of the pneumonia epidemic, preferring conservative treatment for confirmed cases, delaying elective surgeries as much as possible, and performing reasonable surgeries for acute and critical cases" should be followed, which can maximize the saving of patients' lives and avoid the spread of the epidemic.

目的探讨新型冠状病毒肺炎(COVID-19)疫情期间急性主动脉夹层患者合适的治疗方案。方法自2020年1月16日至2月26日,湖北省多个心脏大血管中心共完成37例急性主动脉夹层手术,包括Stanford A型主动脉夹层开放手术18例,Stanford B型主动脉夹层介入手术19例。急性Stanford A型主动脉夹层手术方式包括Stanford升主动脉置换10例(55.55%),Bentall手术7例(38.89% );全弓置换+支架象鼻手术14例(77.8% )。19例急性Stanford B型主动脉夹层行胸主动脉覆膜支架腔内隔绝术,2例同时采用左锁骨下动脉的烟囱技术。结果本组住院30天内无死亡病例。术前核酸检测排除新型冠状病毒感染7例,疑似3例进行急诊手术。大部分手术(62.2%,23/37)采用了三级防护,11例主动脉夹层术后复查病毒核酸检测均为阴性,目前尚未发生医护人员感染及患者交叉感染。结论在疫情期间,术前应仔细鉴别急性主动脉夹层患者是否合并COVID-19。应遵循“肺炎疫情防控为重,确诊病例首选保守,择期手术尽量延迟,急危重症合理手术”治疗原则,可以最大限度挽救患者生命,避免疫情扩散。