The treatment of acute Stanford type A aortic dissection has always been extremely challenging. Organ malperfusion syndrome is a common severe complication of acute aortic dissection, which can cause organ ischemia and internal environment disorder. Malperfusion increases early mortality, and impacts the long-term prognosis. In recent years, many scholars have done some studies on aortic dissection complicated with malperfusion. They explored the pathogenesis, proposed new classification, and innovated new treatment strategies. However, at present, the treatment strategies of acute Stanford type A aortic dissection complicated with organ malperfusion are different at different centers and consensus on its treatment is still lacking. Therefore, this review summarized the pathogenesis, classification, treatment strategy, and prognosis of acute Stanford type A aortic dissection complicated with malperfusion.
ObjectiveTo determine the effectiveness of continuous intercostal nerve block for pain relief after thoracotomy.MethodsFrom November 2017 to October 2018, 120 patients who received thoracotomy procedure in our hospital were collected, including 60 males and 60 females aged 40-77 (58.10±7.00) years. The patients were randomly allocated into three groups by digital table including a continuous intercostal nerve block group (group A, n=40), a single intercostal nerve block group (group B, n=40), and an epidural analgesia group (group C, n=40). All the groups received the same basic analgesia. The pain scores and rescue analgesic doses were compared.ResultsOn postoperative day (POD) 0, all groups achieved effective pain control, and the visual analogue score was 2.02±0.39 points in the group A, 2.13±0.75 points in the group B and 2.03±0.69 points in the group C (P>0.05). On POD 0-2 and POD 3-4 (without basement analgesia), there was no significant difference between the group A and group C in the pain scores (2.08±0.28 points vs. 1.93±0.53 points, 3.20±0.53 points vs. 3.46±0.47 points, P>0.05), however, the difference between POD 0-2 and POD 3-4 in each group was stastically different (group A, 2.08±0.28 points vs. 3.20±0.53 points; group B, 2.42±0.73 points vs. 5.45±0.99 points; group C 1.93±0.53 points vs. 3.46±0.47 points, P<0.05). In terms of the rescue analgesic doses, there was no significant difference between the group A and group C (220.00±64.08 mg vs. 225.38±78.85 mg, P>0.05); it was larger in the group B than that in the group A and group C (343.33±119.56 mg vs. 220.00±64.08 mg; 343.33±119.56 mg vs. 225.38±78.85 mg, P<0.05).ConclusionMultimodal analgesia is an optimal choice in the initial stage after thoracotomy surgery. Continuous intercostal nerve block is an effective way to pain management in patients with thoracotomy.
