中国实用外科杂志

中国实用外科杂志

• 专题笔谈 • 上一篇    下一篇

主动脉钝性伤诊断和治疗

王吉阳，李拥军   

  1. 北京医院血管外科 国家老年医学中心 中国医学科学院老年医学研究院，北京100730
  • 出版日期:2020-12-01 发布日期:2020-12-21

  • Online:2020-12-01 Published:2020-12-21

摘要： 主动脉钝性伤（BTAI）是钝性胸部外伤的致命性损伤之一。根据损伤程度分为4型。BTAI常用诊断技术有4种，CT血管成像（CTA）成为最为常用的确诊方法，成为美国东部创伤外科协会（EAST）的强烈推荐诊断方法。BTAI的治疗方式包括胸主动脉腔内修复（TEVAR）和开放手术治疗，在降低脑卒中、脊髓缺血及肾功能衰竭等发生率方面TEVAR均具有显著的优势，而开放手术还具有较高的移植物和肺部感染率。EAST强烈推荐在确诊的BTAI病人治疗中首选TEVAR治疗。BTAI后24 h内病死率最高，急诊手术治疗被视为手术时机的最佳选择。但对于Ⅰ、Ⅱ 型病人延期手术（损伤16 h后）病人获益更大。另外，TEVAR手术的抗凝及脑脊液引流将视病人情况而定。

关键词: 胸主动脉钝性损伤, 胸主动脉腔内修复

Abstract: Diagnosis and treatment of blunt aortic injury        WANG Ji-yang, LI Yong-jun. Department of Vascular Surgery, Beijing Hospital/National Center for Geriatrics, Peking Union Medical College, Beijing 100730, China
Corresponding author：LI Yong-jun，E-mail：liyongjun4679@
bjhmoh.cn
Abstract    Blunt thoracic aortic injury（BTAI）is one of the fatal injuries of blunt thoracic trauma，and its mechanism has not been defined yet. There are four types according to the degree of damage. There are four commonly used diagnostic techniques for the BTAI. CT Aortography（CTA）has become the most commonly method to determine a patient's aortography，and it is the strongly recommended diagnostic method of the Eastern Association for the Surgery of Trauma，EAST. BTAI treatment methods include thoracic endovascular aortic repair（TEVAR）and open surgical treatment，which have significant advantages in reducing stroke，spinal cord ischemia，renal failure and other aspects，while open surgery has a higher rate of graft and lung infection. EAST strongly recommends TEVAR as the first treatment option for confirmed BTAI patients. The mortality rate was highest within 24 h after BTAI，and emergency surgical treatment was considered the best choice for surgical timing. However， patients with delayed surgery for type Ⅰ and type Ⅱ（16 h after injury）will benefit more. In addition，anticoagulation and cerebrospinal fluid drainage during TEVAR surgery will depend on the patient.

Key words: blunt thoracic aortic injury, thoracic endovascular aortic repair