摘要
目的探讨急性Stanford A型主动脉夹层患者术后发生肝功能不全(HD)的危险因素和预后。方法回顾性分析青岛市市立医院2014年5月至2018年5月156例接受外科手术的急性Stanford A型主动脉夹层患者围术期资料。采用终末期肝病模型(MELD)评分评估患者术后肝功能,并分为HD组35例(MELD评分≥15分)和非HD组121例(MELD评分<14分)。所有患者围术期主要指标进行单因素分析和多因素logistic回归分析,并比较两组患者的预后。结果156例患者中住院期间死亡13例(8.3%),HD组患者死亡7例(20.0%),非HD组患者死亡6例(5.0%)。两组患者术前血清肌酐和谷丙转氨酶水平、体外循环时间、白细胞计数、D-二聚体、术前EuroSCORE评分、主动脉弓置换手术、术中及术后24 h红细胞输注量比较,差异均有统计学意义(均为P<0.05)。多因素分析显示,术前谷丙转氨酶水平升高(OR=1.244,95%CI:1.100~1.406,P=0.001)、体外循环时间延长(OR=1.104,95%CI:1.041~1.170,P=0.001)、术中及术后24 h红细胞输注量增加(OR=4.717,95%CI:2.278~9.767,P=0.000)是术后HD的独立危险因素。平均随访(22.9±3.2)个月,失访率9.1%,HD组患者近中期死亡率高于非HD组(14.3%比2.6%,Log-rank P=0.009)。结论急性Stanford A型主动脉夹层患者术后HD的发生率仍较高。术前谷丙转氨酶水平升高、体外循环时间延长、术中及术后24 h红细胞输注量增加是术后HD的独立危险因素。术后HD患者近中期死亡率明显增加。
Objective To explore the prognosis and risk factors of postoperative hepatic dysfunction(HD)in patients with Stanford type A acute aortic dissection.Methods Patients with Stanford type A acute aortic dissection who underwent surgery in Qingdao Municipal Hospital from May 2014 to May 2018 were retrospectively analyzed.Postoperative model for end-stage liver disease(MELD)score was used to define HD.Patients were divided into two groups based on their hepatic function.There were 35 patients in HD group(MELD≥15)and 121 patients in non-HD group(MELD<15).Univariable and multivariable logistic regression analysis were used to identify the predictive risk factors.The prognosis of the two groups was compared.Results A total of 156 patients were enrolled.Overall in-hospital mortality was 8.3%(13 cases).Mortality in HD group was 20.0%(7 cases),while that in non-HD group was 5.0%(6 cases).Univariate analysis showed that there were significant differences in preoperative alanine aminotransferase(ALT),preoperative creatinine,cardiopulmonary bypass(CPB)time,preoperative leucocyte,preoperative D-dimer,European system for cardiac operative risk evaluation(EuroSCORE),intraoperative and 24 h postoperative red blood cell transfusion volume and number of aortic arch surgery between the two groups.Multivariate logistic analysis showed that preoperative ALT(OR=1.244,95%CI:1.100-1.406,P=0.001),CPB time(OR=1.104,95%CI:1.041-1.170,P=0.001),and red blood cell transfusion(OR=4.717,95%CI:2.278-9.767,P=0.000)were the independent risk factors for postoperative HD.The average time of follow-up was(22.9±3.2)months,and the lost follow-up rate was 9.1%.The short-and middle-term mortality was higher in HD group than that in non-HD group(14.3%vs.2.6%,Log-rank P=0.009).Conclusions The incidence of postoperative HD is high in patients with Stanford type A acute aortic dissection.Elevated preoperative ALT,prolonged CPB time,and red blood cell transfusion volume during and 24 h after surgery are the independent risk factors for postoperative HD.The short-and middle-term mortality of these patients are significantly increased.
作者
生伟
曹宴宾
王天毅
李好友
张文峰
吴建涛
牛兆倬
Sheng Wei;Cao Yanbin;Wang Tianyi;Li Haoyou;Zhang Wenfeng;Wu Jiantao;Niu Zhaozhuo(Department of Cardiovascular Surgery,Qingdao Municipal Hospital,Medical College of Qingdao University,Qingdao 266071,China;Department of Neurosurgery,Weihai Municipal Hospital,Weihai 264200,China)
出处
《中国心血管杂志》
2022年第1期43-48,共6页
Chinese Journal of Cardiovascular Medicine
基金
青岛市医药科研指导计划(2019-WJZD012)。
关键词
动脉瘤
夹层
肝功能不全
危险因素
预后
Aneurysm,dissecting
Hepatic insufficiency
Risk factors
Prognosis
