Shanghai Fourth Hospital successfully treated a patient with complex type A aortic dissection with multidisciplinary treatment
The Fourth People's Hospital of Shanghai affiliated to Tongji University successfully treated a patient with acute type A aortic dissection. The patient has recovered and been discharged from hospital a few days ago.
It is understood that in late April, 65-year-old Mr. Jiang suffered from severe chest pain when he woke up in the morning, which radiated to his back and neck for about an hour and a half, so he came to the Chest Pain Center of Shanghai Fourth Hospital for treatment. Mr. Jiang described the onset of the disease as tearing and knife-like pain that could not be relieved by nitroglycerin, accompanied by palpitations and difficulty breathing. The situation was very urgent. In addition, Mr. Jiang is thin, with a height of 172 centimeters and a weight of just over 50 kilograms, and his blood pressure is not very stable. According to his family members, Mr. Jiang’s blood pressure was not well controlled at ordinary times and fluctuated widely.
The medical staff of the Chest Pain Center of Shanghai Fourth Hospital immediately conducted a preliminary assessment of Mr. Jiang and found that he had severe cardiovascular emergency symptoms. They immediately initiated the first aid process, including monitoring vital signs, administering oxygen inhalation, establishing intravenous access, analgesia, sedation, Control blood pressure, etc. At the same time, the chest pain center quickly contacted various departments of Shanghai Fourth Hospital and quickly held a joint MDT consultation, including the medical department, emergency department, chest pain center, ultrasound department, imaging department, cardiac surgery, anesthesiology department, operating room, blood transfusion department and other related departments. participate. Finally, after enhanced CT examination of the aorta, Mr. Jiang was diagnosed with acute type A aortic dissection.
At 20:30 on the evening of April 29, Mr. Jiang was quickly transferred to the operating room for emergency surgery, performed by Yu Shiqiang, honorary director of the cardiovascular surgery department of Shanghai Fourth Hospital, with the cooperation of executive director Zhao Bijun and attending physician Yang Qinghua. After intraoperative exploration, it was found that the proximal end of the dissection had involved the aortic sinus and right coronary artery, and the innominate artery and left common carotid artery were also combined with thrombosis, making the operation extremely difficult. After more than 6 hours, Mr. Jiang completed the operation at 2:47 a.m. the next day and returned safely to the ICU ward. The operation was successfully completed.
"The success of the operation does not mean that Mr. Jiang can fully recover. Observation of postoperative complications is as important as nursing care." Yu Shiqiang, honorary director of cardiovascular surgery, said that with the help of the ERAS concept of the hospital's rehabilitation department, Mr. Jiang's surgery was optimized. Comprehensive care before, during and after surgery to better promote his early recovery and functional recovery. First, the Intensive Care Unit and Rehabilitation Physiotherapy Department developed a personalized exercise guidance plan based on Mr. Jiang’s recovery, gradually guiding him to engage in moderate activities to promote the recovery of physical functions.
Secondly, the medical team also paid attention to Mr. Jiang’s diet and nutritional support to ensure that he had enough protein, vitamins and minerals to promote wound healing and physical recovery. In addition, the medical team also focused on his emotional management and psychological support. The nursing team helped Mr. Jiang build confidence in overcoming the disease and maintain a good attitude by listening, comforting and encouraging.
After a period of careful care and rehabilitation guidance, Mr. Jiang's condition has improved significantly. As the surgical wound gradually heals, his body's strength is quietly returning. Mr. Jiang went from standing beside the bed to walking indoors and then walking outdoors. His mobility improved significantly and he gradually returned to normal life.
Yu Shiqiang said that aortic dissection is a serious cardiovascular disease. It occurs when the inner layer of the aorta tears, causing blood to enter the middle layer of the aortic wall from the tear, causing the layers of the aortic wall to separate to form a New blood channels, the dissection. This situation results in a shunt of blood flow between the true vessel lumen and the dissection lumen, which may cause further tearing or even rupture of the aortic wall, causing life-threatening consequences. Aortic dissection is usually divided into two types based on the location of the tear: type A dissection and type B dissection.
“Type A aortic dissection: occurs in the ascending part of the aorta, that is, involves the ascending aorta and aortic arch. This type of dissection is the most dangerous. The typical clinical symptoms are severe cutting or tearing pain in the chest and back. , requiring emergency surgical treatment. 1% of patients die due to dissection rupture every hour after onset. If surgery is not performed in time, nearly half of the patients will die within 48 hours of onset, which is called the human body's 'ticking time bomb'. Therefore, type A aorta. "Dissection requires urgent medical intervention and surgical treatment," Yu Shiqiang said. Type B aortic dissection: occurs in the descending part of the aorta. Treatment may include medication and/or surgery, depending on the severity of the condition and the patient's condition. Overall condition.
How to prevent aortic dissection? Yu Shiqiang said that the most important thing is to reduce known risk factors: including controlling blood pressure, limiting tobacco and alcohol intake, eating healthily, exercising moderately, controlling weight, regular physical examinations, reducing stress, etc. However, even with all precautions taken, the risk of aortic dissection cannot be completely ruled out. Therefore, it is important to know the symptoms of aortic dissection and seek medical attention immediately if symptoms occur.
