摘要
目的探讨急性Stanford A型主动脉夹层(ATAAD)患者围手术期并发症和术后死亡的危险因素。方法回顾性分析2013年1月至2021年7月期间济宁医学院附属医院连续手术的228例ATAAD患者围术期资料,分析并发症,根据术后30 d内的生存情况分为死亡组(24例)和存活组(204例),行单因素和多因素logistic回归分析患者术后死亡的危险因素。绘制受试者工作特征(ROC)曲线评价各危险因素对ATAAD患者术后死亡的预测效能。结果ATAAD患者术前并发症前三位为低氧血症(10.1%,23/228)、心包填塞(7.9%,18/228)、肾功能不全(5.3%,12/228),术后并发症前三位为低氧血症(75.9%,173/228)、肾功能不全(26.8%,61/228)、肝功能不全(26.3%,60/228)。共死亡24例,病死率10.5%(24/228)。多因素logistic回归分析结果显示,年龄≥55岁(OR=7.733,95%CI:1.986~30.111,P=0.003)、术前心包填塞(OR=5.641,95%CI:1.546~20.577,P=0.009)、体外循环(CPB)时间≥200 min(OR=1.008,95%CI:1.002~1.014,P=0.007)、术后肾功能不全(OR=5.875,95%CI:1.927~17.907,P=0.002)是ATAAD术后患者早期死亡的独立危险因素,各危险因素联合预测死亡概率的曲线下面积为0.905(95%CI:0.820~0.950,P<0.001),预测的灵敏度为88.4%,特异度为76.5%。结论ATAAD围术期并发症多见,病死率高。年龄≥55岁、术前合并心包填塞、CPB时间≥200 min、术后肾功能不全为ATAAD患者术后死亡的独立危险因素。
Objective To investigate the perioperative complications and risk factors of postoperative death in patients with acute Stanford type A aortic dissection(ATAAD).Methods The perioperative data of 228 patients with ATAAD who underwent continuous surgery in the Affiliated Hospital of Jining Medical University from January 2013 to July 2021 were retrospectively analyzed.The complications were analyzed.According to the survival within 30 days after surgery,they were divided into death group(24 cases)and survival group(204 cases).The risk factors of postoperative death were analyzed by univariate and multivariate logistic regression.The receiver operating characteristic(ROC)curve was drawed to evaluate the predictive efficacy of various risk factors on postoperative death of ATAAD patients.Results The first three complications before operation were hypoxemia(10.1%,23/228),pericardial tamponade(7.9%,18/228),renal insufficiency(5.3%,12/228),the first three complications after surgery were hypoxemia(75.8%,173/228),renal insufficiency(26.8%,61/228)and liver insufficiency(26.3%,60/228).A total of 24 patients died,the fatality rate was 10.5%(24/228).Logistic regression analysis showed that age≥55 years old(OR=7.733,95%CI:1.986-30.111,P=0.003),preoperative pericardial tamponade(OR=5.641,95%CI:1.546-20.577,P=0.009),cardiopulmonary bypass time(CBP)≥200 min(OR=1.008,95%CI:1.002-1.014,P=0.007)and postoperative renal insufficiency(OR=5.875,95%CI:1.927-17.907,P=0.002)were independent risk factors for early death after ATAAD.The area under the ROC curves of joint prediction was 0.905(95%CI:0.820-0.950,P<0.01).The sensitivity and specificity of joint prediction were 88.4%,76.5%,respectively.Conclusions ATAAD has many perioperative complications and high mortality.Age≥55 years old,preoperative pericardial tamponade,CPB time≥200 min,and postoperative renal insufficiency were independent risk factors for postoperative death in ATAAD patients.
作者
费忠化
蔡腾
张毅
汤丽
刘新梅
刘宏生
Fei Zhonghua;Cai Teng;Zhang Yi;Tang Li;Liu Xinmei;Liu Hongsheng(Department of Cardiovascular ICU,Affiliated Hospital of Jining Medical University,Jining 272029,China;School of Clinical Medicine,Jining Medical University,Jining 272029,China)
出处
《中国医师杂志》
CAS
2022年第7期1042-1046,共5页
Journal of Chinese Physician
基金
山东省高等学校科技计划项目(J17KA231)。
关键词
动脉瘤
夹层
围手术期并发症
死亡
危险因素
Aneurysm,dissecting
Perioperative complications
Death
Risk factors
