夜间急诊主动脉夹层手术并不增加住院死亡率  

Emergency Operation at Midnight Does Not Increase In-hospital Mortality in Patients with Acute Aortic Dissection

作　　者：秦卫[1,2] 黄福华[1,2] 肖立琼[1,2] 刘圣辰[1,2] 陈鑫[1,2] 

机构地区：[1]南京医科大学附属南京医院 [2]南京市心血管病医院心胸血管外科,南京210006

出　　处：《中国胸心血管外科临床杂志》2013年第5期542-545,共4页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

基　　金：国家卫生和计划生育委员会课题资助项目(20142009)~~

摘　　要：目的分析急性Stanford A型主动脉夹层患者夜间手术与白天手术的疗效差异。方法 2004年1月至2013年3月,195例急性Stanford A型主动脉夹层患者在南京医科大学附属南京医院(南京市心血管病医院)接受手术治疗,从白天急诊手术患者(127例)中选出与晚夜间手术患者(68例)倾向指数相同或相近的个体进行配对,共匹配58对患者,包括夜间手术组[n=58,男45例,女13例,(48.3±14.6)岁]和白天手术组[n=58,男43例,女15例,(47.7±14.6)岁]。比较分析两组患者的手术时间、术后胸腔引流量、术后机械通气时间、术后透析率、气管切开率、住ICU时间、住院死亡率。结果夜间手术组患者术后气管切开率[19.0%(11/58)vs.6.9%(4/58),P=0.053]、住院死亡率[8.6%(5/58)vs.6.9%(4/58),P=0.729]与白天手术组相比较差异无统计学意义。夜间手术组与白天手术组比较,前者手术时间延长[(485.7±93.5)min vs.(428.5±123.3)min,P=0.048]、术后胸腔引流量偏多[(979.5±235.7)ml vs.(756.6±185.9)ml,P=0.031]、机械通气时间延长[(67.9±13.8)h vs(.55.7±11.9)h,P=0.025]、术后透析率增加[17.2%(10/58)vs.5.2%(3/58),P=0.039]、住ICU时间延长[(89.4±16.2)h vs.(74.8±12.5)h,P=0.023]。术后随访107例患者,随访时间4～6个月。随访期间无死亡,13例术后透析患者中有12例已经不需要定期行透析治疗。结论夜间急诊主动脉夹层手术并不增加住院死亡率,但是增加术后一些并发症的发生率。无论是夜间还是白天,对急性Stanford A型主动脉夹层患者都应该以更充分地准备、更饱满地精力去积极认真对待,必要时应及时手术治疗。Objective To compare surgical outcomes of Stanford type A acute aortic dissection between opera- tions at midnight and daytime. Methods From January 2004 to March 2013, 195 patients with Stanford type A acute aortic dissection received surgical treatment in Nanjing Hospital Affiliated to Nanjing Medical University （Nanjing Car- diovascular Disease Hospital）. Patients with identical or similar propensity scores were matched from 127 patients who underwent emergency operation at daytime and 68 patients who underwent emergency operation at midnight. A total of 58 pairs of matched patients which had the same or similar propensity score were selected in daytime surgery group （n=58, 43 males and 15 females, 47.7___ 14.6 years）and midnight surgery group （n=58, 45 males and 13 females, 48.3~ 14.6 years）. Operation time, postoperative chest drainage, mechanical ventilation time, postoperative incidence of dialysis and tracheostomy, length of ICU stay and in-hospital mortality were compared between the daytime group and midnight group. Results A total of 58 pair of patients were matched in this study. There was no statistical difference in postopera- tive incidence of tracheostomy [ 19.0% （ 11/58 ） vs. 6.9% （4/58）, P=0.053 ] or in-hospital mortality [ 8.6% （5/58） vs. 6.9% （ 4/58 ）, P=0.729 ] between the midnight group and daytime group. Operation time （ 485.7 ± 93.5 minutes vs. 428.5 ± 123.3 minutes, P=0.048）, postoperative chest drainage （979.5 ± 235.7 ml vs. 756.6 ±185.9 ml,p=0.031 ）, mechanical ventilation time （ 67.9 ± 13.8 hours vs. 55.7 _ 11.9 hours, P=-0.025 ）, postoperative incidence of dialysis [ 17.2% （ 10/58 ） vs. 5.2% （3/58）, P=0.039 ] and length of ICU stay （ 89.4-t- 16.2 hours vs. 74.8 _ 12.5 hours, P=0.023 ） of the midnight group were significantly longer or higher than those of the daytime group. A total of 107 patients were followed up for 4-6 months after discharge. During follow-up, there was no late death. Among the 13 patients who required postop

关 键 词：STANFORD A型 主动脉夹层 倾向得分法 手术治疗 并发症 死亡率 

分 类 号：R654.3[医药卫生—外科学]