摘要
目的分析Stanford A型主动脉夹层手术后病人发生急性呼吸功能不全（ARD）的相关危险因素，为制定预防和治疗措施提供依据。方法2009年2月至2010年10月在深低温（鼻温降至18℃）停循环下行主动脉替换术的A型主动脉夹层病例252例，其中男193例，女59例；平均年龄（47±11）岁。术前诊断急性A型夹层187例（发病〈2周），慢性A型夹层65例。记录病人的年龄、性别、术前合并症、既往主动脉手术史、主动脉夹层类型、有无灌注不良综合征、手术方式、体外循环转流时间和术后并发症。监测术前及术后的血气分析、胸部X线平片、呼吸机参数及术中和术后24h输血、输液数量。对术后ARD发生的相关危险因素进行单因素分析及多因素logistic回归分析。结果32例（12．7％）术后早期（〈72h）出现ARD。ARD组和非ARD组住院病死率差异有统计学意义（P〈0．05）。ARD组体重指数、急性夹层所占比例、术前收缩压、体外循环和主动脉阻断时间、全弓置换手术明显高于非ARD组，术中红细胞压积明显低于非ARD组（P〈0．05）。多元logistic回归分析显示，术中及术后24h内输浓缩红细胞〉10U及体外循环转流时间〉160min是ARD的独立危险因素。结论A型主动脉夹层手术后早期ARD与住院病死率相关，术中及术后24h内输浓缩红细胞〉10U和体外循环转流时间〉160min是术后早期ARD的独立危险因素。
Objective Acute respiratory dysfunction （ARD） can occur after aortic surgery with the use of cardiopulmonary bypass and deep hypothermic circulation arrest, but relatively little is known about acute respiratory dysfunction in the patients with type A aortic dissection. This study aims to analyze the independent risk factors of acute respiratory dysfunction after A type aortic dissection surgery and to assess possible prevention and treatment option in the future. Methods Clinical data of the 252 patients including 193 male patients and 59 female patients who underwent type A aortic dissection surgery from February 2009 to October 2010 were collected. The mean age was 47 years. Postoperative acute respiratory dysfunction was defined as oxygenation impairment （PaOe/FiO2 〈 150） that occurred within 72 h of surgery except pleural effusion, cardiogenic pulmonary edema, pneumonia, pulmonary embolism and haemato-/pneumothorax. There were 187 acute A type aortic dissection patients and 65 chronic type A aortic dissection patients. Clinical characteristics including age, gender, weight, height, history of hypertension, history of smoking, preoperative complications such as preoperative shock and acute renal failure, pericardial effusion, previous cardiac surgery, time from event to surgery, malperfusion syndrome, cardiopulmonary time, cross-clamp time, deep hypothermia circulation arrest time, surgical procedure, duration of intensive care unit stay and postoperative complications including tracheotomy, dialysis dependent renal failure and hospital mortality were gathered. Arterial blood analysis, chest X ray, ventilator parameters, number of blood transfusion and flood balance were assayed after operation. All the factors were evaluated by means of univariate and multivariate logistic regression analysis to identify relative risk factors of ARD. Results Acute respiratory dysfunction occurred in 32 （ 12.7% ） patients. The in-hospital mortality was significant difference betweenacute respiratory dysfunction group and nonacute respiratory dysfunction group （P 〈0.05 ）. The value of BMI, incidence of acute aortic dissection, preoperative SBP level, cardio-pulmonryy bypass time, aortic clamp time and total arch replacement in acute respiratory dysfunction group were significantly higher than the values in nonacute respiratory dysfunction group. Multivariate Logistic regression analysis showed blood transfusion more than 10 units and cardio-pulmonary bypass time more than 160 minutes were independent risk factors of early stage acute respiratory, dysfunction after type A aortic dissection surgery. Conclusion Acute respiratory dysfunction after type A aortic dissection was a severe early stage postoperative complication and was associated with in-hospital mortality. The patients in acute aortic dissection were prone to have acute respiralory dysfunction. The independent risk factors of acute respiratory dysfunction included blood transfusion more than 10 units and cardio-pulmonary bypass time more than 160 minutes.
出处
《中华胸心血管外科杂志》
CSCD
北大核心
2011年第6期349-352,共4页
Chinese Journal of Thoracic and Cardiovascular Surgery
关键词
动脉瘤
夹层/外科学
急性呼吸功能不全
危险因素
Aortic aneurysm, dissection/surgery Acute respiratory dysfunction Risk factors
