急性主动脉夹层动脉瘤术后低氧血症发生的危险因素分析  

Risk Factors for Hypoxemia after Surgery for Acute Aortic Dissection

作　　者：生伟[1] 池一凡[1] 侯文明[1] 孙龙[1] 牛兆倬[1] 孙勇[1] 林明山[1] 吕晓[1] 

机构地区：[1]青岛市市立医院心脏外科,山东青岛266071

出　　处：《中国胸心血管外科临床杂志》2013年第3期298-303,共6页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

摘　　要：目的探讨急性主动脉夹层动脉瘤术后低氧血症发生的危险因素。方法回顾性分析2007年2月至2012年2月青岛市市立医院116例急性主动脉夹层动脉瘤患者经主动脉腔内隔绝术或开胸手术治疗的临床资料。116例患者均经CT血管成像(CTA)确诊主动脉夹层动脉瘤,其中Stanford A型60例,Stanford B型56例。根据术后是否发生低氧血症,将116例急性主动脉夹层动脉瘤患者分为低氧血症组[动脉血氧分压(PaO2)/吸入氧浓度(FiO2)<200 mm Hg]:33例,男28例,女5例;年龄(52.7±11.4)岁;非低氧血症组(PaO2/FiO2≥200 mm Hg):83例,男66例,女17例;年龄(55.0±13.8)岁。分析和比较两组患者的围术期相关资料,采用多因素logistic回归分析急性主动脉夹层动脉瘤患者术后发生低氧血症的危险因素。结果急性主动脉夹层动脉瘤术后低氧血症发生率为28.4%(33/116),围术期死亡13例(11.2%,其中低氧血症组8例,非低氧血症组5例)。单因素分析结果显示:术前低氧血症组患者体重指数>25 kg/m2的比率、有吸烟史比率、发病至手术时间<24 h比率、术前PaO2/FiO2≤300 mm Hg和开胸手术比率均大于非低氧血症组(P<0.05)。低氧血症组深低温停循环比率、术后24 h输血量、呼吸机辅助呼吸时间、ICU滞留时间和住院时间高于或多于非低氧血症组(P<0.05)。开胸手术患者logistic多因素回归分析结果显示:体重指数>25 kg/m(2OR=98.861,P=0.006)、深低温停循环(OR=22.487,P=0.007)、术前PaO2/FiO2≤300 mm Hg(OR=9.080,P=0.037)和术后24 h内输血量>6 U(OR=32.813,P=0.003)为急性主动脉夹层动脉瘤患者手术后发生低氧血症的独立危险因素。单纯行降主动脉腔内隔绝术患者的logistic回归分析显示,体重指数>25 kg/m2(OR=24.984,P=0.036)和术前PaO2/FiO2≤300 mm Hg(OR=21.145,P=0.042)为发生低氧血症的独立危险因素。结论低氧血症是急性主动脉夹层动脉瘤术后常见的并发症,及早纠治肥胖、术前低氧血症,减少�Objective To determine risk factors associated with postoperative hypoxemia after surgery for acute aortic dissection. Methods We retrospectively analyzed clinical data of 116 patients with acute aortic dissection who underwent endovascular stent-graft exclusion or open surgery in Qingdao Municipal Hospital from February 2007 to February 2012. All the 116 patients were diagnosed as acute aortic dissection by CT angiography （CTA）, including 60 patients with Stanford type A aortic dissection and 56 patients with Stanford type B aortic dissection. According to whether they had postoperative hypoxemia, all the 116 patients with acute aortic dissection were divided into hypoxemia group [ arterial partial pressure of oxygen （PaO2）/fraction of inspired oxygen （FiO2） 〈 200 mm Hg ] ： 33 patients including 28 males and 5 females with their age of 52.7 ± 11.4 years; and non-hypoxemia group （PaO2/FiO2 ≥200 mm Hg） ： 83 patients including 66 males and 17 females with their age of 55.0± 13.8 years. Perioperative clinical data were analyzed and comparedbetween the two groups. Multivariate logistic regression was performed to identify risk factors of postoperative hypoxemia after surgery for acute aortic dissection. Results The incidence of postoperative hypoxemia after surgery for acute aortic dissection was 28.4% （33/116）. Perioperative death occurred in 13 patients （ 11.2%, including 8 patients in the hypox- emia group and 5 patients in the non-hypoxemia group）. Univariate analysis showed that preoperatively the percentages of patients with body mass index （BMI） 〉 25 kg/m2, smoking history, duration from onset to operation 〈 24 h, preoperative PaO2/FiO2 ≤ 300 mm Hg, and patients undergoing open surgery in the hypoxemia group were significantly higher than those in the non-hypoxemia group （P 〈 0.05）. Deep hypothermic circulatory arrest （DHCA）ratio, blood transfusion in 24 hours postoperatively, mechanical ventilation time, length of ICU stay and hospital stay in the hypoxemi

关 键 词：急性主动脉夹层动脉瘤 低氧血症 危险因素 

分 类 号：R654.3[医药卫生—外科学]