How to treat aortic dissection?
summary
Aortic dissection is not an incurable disease. With the rapid development of medical treatment, the success rate of treating aortic dissection has improved a lot. I am one of them, so I still have a say in the treatment of aortic dissection. Here I want to share my experience with you.
How to treat aortic dissection?
Early emergency treatment all patients with suspected aortic dissection should be admitted to the emergency intensive care unit immediately to monitor blood pressure, heart rate, central venous pressure, urine volume, pulmonary artery wedge pressure and cardiac output if necessary. The purpose of early treatment is to reduce the pain, reduce the systolic blood pressure to 100-110mmhg or to a low level that can maintain the perfusion of important organs such as heart, brain and kidney. At the same time, whether there is systolic hypertension or pain should be given β- The heart rate can be controlled at 60-75bpm to reduce DP / DT, which can effectively stabilize or stop the continuous expansion of aortic dissection.
Medical drug therapy mainly focuses on two aspects: ① reducing systolic blood pressure; ② The left ventricular ejection velocity (DP / DT) was decreased. It is believed that the latter is an important factor in the formation and expansion of aortic dissection. At first, medical treatment was only used for patients who were seriously ill and could not tolerate surgery. Now, medical treatment is the basis of early treatment for all patients with aortic dissection before imaging diagnosis, and can also be used as a long-term treatment for some patients.
Surgical treatment; Surgical operation is to remove the tear of intima, prevent massive hemorrhage caused by the rupture of dissection, and reconstruct the blood flow in the area of vascular obstruction caused by intima slice or false lumen（ 1) In order to prevent the rupture or deterioration of acute type A aortic dissection, surgical treatment should be performed as soon as possible. Type A dissection needs to be performed under extracorporeal circulation. The key of operation is to find the location of intimal rupture, to make clear the situation of distal outflow tract of dissection, and to adopt different operation methods (ascending aorta replacement, Bentall operation, sun operation, etc.) according to different lesions. In recent years, some scholars have tried endovascular treatment of type A aortic dissection（ 2) With the development of endovascular technology and stent materials, type B aortic dissection is more and more isolated by covered stent, which has the advantages of less trauma, less bleeding, rapid recovery and low mortality. It is especially suitable for the elderly and poor general condition who can not tolerate traditional surgery, and has become the standard treatment for complex type B aortic dissection, Compared with traditional open surgery, it can reduce the incidence of perioperative complications.
matters needing attention
Because once this disease occurs, the probability of death is particularly high in 24 hours after the onset. And in this aspect of care is a very high demand. For patients with aortic dissection, friends and family members of patients should pay attention, because once this disease occurs, we also mentioned above how serious the consequences are. So in peacetime we should pay attention to the blood pressure of patients, but also pay attention to let patients stay in bed.
