Journal of Chest Surgery

  • 제35권12호
  • /
  • Pages.876-881
  • /
  • 2002
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  • 2765-1606(pISSN)
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  • 2765-1614(eISSN)
대한심장혈관흉부외과학회 (The Korean Society for Thoracic and Cardiovascular Surgery)
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급성 대동맥박리증의 수술성적 및 수술전 처치에 대한 임상적 고찰

Clinical Analysis of Surgical Results and Preoperative Management of Acute Aortic Dissection

  • 현성열 (가천의과대학 길병원 응급센타 흉부외과) ;
  • 박국양 (가천의과대학 길병원 흉부외과학 교실) ;
  • 이재웅 (가천의과대학 길병원 응급센타 흉부외과) ;
  • 이창하 (가천의과대학 길병원 흉부외과학 교실) ;
  • 전양빈 (가천의과대학 길병원 흉부외과학 교실) ;
  • 박철현 (가천의과대학 길병원 흉부외과학 교실) ;
  • 염석란 (가천의과대학 길병원 응급의학과 교실) ;
  • 신종환 (가천의과대학 길병원 응급의학과 교실) ;
  • 민순식 (가천의과대학 길병원 응급의학과 교실)
  • 발행 : 2002.12.01
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초록

대동맥박리증은 사망률이 매우 높은 질환으로 조기 진단 및 치료가 되지 않으면 예후가 매우 불량한 질환이다. 최근 컴퓨터단층화촬영과 심초음파 기술의 발달로 진단률이 높아지고 조기수술이 가능하게 되었으며 술전 응급실에서 적극적인 약물투여로 사망률이 낮아지고 있는 상태이다. 따라서 이 연구는 후향적으로 응급실에서의 처치 및 수술 결과를 분석하였다. 대상 및 방법: 1991~2001년까지 외과적 교정술을 시행받은 급성 대동맥박리증 환자 42명을 대상으로 하였다. 남자가 18례, 여자가 24례였으며 연령은 평균 51.1세였다. 또한 응급실을 경유한 경우가 34례, 외래를 통한 입원이 8례였다. 결과: 수술은 상행대동맥치환술이 26례였으며 이중 대동맥판막 치환술을 병행한 경우가 7례였다. 하행대동맥치환술은 7례였으며 Bentall술식은 9례에서 시행하였다. 응급실 내원시 혈압강하제와 $\beta$-수용체차단제를 20례에서 투여하였으며 이중 6111(30%)에서 사망하였다. 이런 약물을 투여하지 않은 22례환자중 10례(45.5%)에서 사망하였다. 전체 사망은 16례(38%)였다. 결론: 대동맥박리증은 응급실이나 외래에서 조기진단이 필요하며 가능한한 비침습적 검사방법을 택하고 환자상태에 따라 적극적인 술전 약물처치가 이루어져야 할 것으로 생각된다.

Acute aortic dissection associated with high mortality rate has an extremely poor prognosis if early diagnosis and treatment are not received. Recently, with advanced computed tomography and echocardiography, diagnostic rate is higher and early operation is possible. Therefore preoperative medical therapy at ER(emergency room) lowered the mortality rate. This study was done to analyze the results with preoperative management at ER and operations, retrospectively. Material and Method: A series of 42 patients treated surgically for acute aortic dissections from 1991 to 2001 were included in this study. There were 18 males and 24 females. Mean age was 51.1 years. The admission course through emergency and outpatient department(OPD) was 34 and 8 respectively. Result: 26 patients underwent ascending aorta replacement-7 combined aortic valve replacements, 7 patients underwent descending aorta replacements and 9 patients received Bentall's operation. At emergency department, 20 patients received antihypertensive drugs and $\beta$-receptor blockers and 6 patients died. 22 patients did not receive antihypertensive and $\beta$-receptor block drugs and 10 patients died. There were 16(38%) overall deaths. Conclusion: Early diagnosis at ER or OPD is essential for acute aortic dissection, and it is important to select the most appropriate noninvasive interventions as possible. Therefore, preoperative drug therapy at ER is suggested according the patient conditions.

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참고문헌

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