多模态“影像”集成个体化预测急性DebakeyⅠ型主动脉夹层外科治疗后的再发破裂

项目名称： 多模态“影像”集成个体化预测急性DebakeyⅠ型主动脉夹层外科治疗后的再发破裂

项目编号： No.81500367

项目类型： 青年科学基金项目

立项/批准年度： 2016

项目学科： 医药、卫生

项目作者： 赵鑫

作者单位： 山东大学

项目金额： 18万元

中文摘要： 急性Debakey I型AD患者经主动脉弓替换+支架象鼻手术治疗后，其早期评价远端残余夹层愈合越好，再发破裂的可能性越小，则预后就越好。因此胸降主动脉的重塑效果和远端残留夹层是影响患者预后的重要因素。我们认为利用MCTA测定治疗后真假腔的变化、彩色多普勒超声测定残余假腔内的血流动力学改变、以及凝血系列和TEG动态监测远端残余假腔内凝血和血小板功能状态，也许能判断AD术后远端残余夹层的愈合程度，从而评估再发破裂的风险，然而上述假设均尚未得到证实。本项目在前期工作基础上，拟通过MCTA、彩色多普勒超声、凝血系列和TEG相应客观量化指标集成的多模态影像，个体化预测急性Debakey I型AD经主动脉弓置换+支架象鼻手术后再发破裂的风险因素，探索预测远端残余夹层进展的风险模型，以便尽早评估筛选再发破裂的高危患者和最佳评估时间窗，从而有利于我们提前治疗干预，降低患者外科治疗后再发破裂的风险。

中文关键词： 主动脉夹层；外科手术；计算机成像；超声；凝血

英文摘要： Total arch replacement with stented elephant trunk implantation is applied as the standard treatment in patients with Debakey type I aortic dissection (AD) in China. If the distal residual dissection in descending or abdominal aorta become self-healing in early-term after undergoing the technique, it is impossible for the recurrent rupture to happen. So both remodeling effect of descending aorta and distal residual dissection are the vital factors to affect the prognosis. We think that the judgement for the healing of distal residual dissection after total arch replacement with stented elephant trunk implantation may be achived through multiple combination of examination and test. We can measure the diameter ratios between the stent or true lumen and aorta through the multi-slice spiral computed tomographic-angiography (MCTA), detect hemodynamics in false lumen with color doppler ultrasound, and monitor the coagulation function by routine blood test and thromboelastography (TEG). Those postoperative techniques are used for access the risk of recurrent rupture. But that hypothesis has been not verified through further research. In all, we try to study the risk factor of recurrent rupture of residual dissection in acute Debake type I AD patients undergoing the stented elephant trunk implantation though the objective quantification MCTA index, color duppler ultrasound, coagulation series and TEG test. The aim of study is to explor the risk model to predict the development of residual dissection in order to distinguish the high-risk group of recurrent ruptrue. Ultimately, we can provide the intervention treatment in advance and reduce the rupture after surgery.

英文关键词： aortic dissection;surgery;computerized tomography;ultrasonic sound;coagulation