主动脉夹层围术期的高危因素  

High risk factors of aortic dissection during perioperative period

作　　者：张伸[1] 杨敏[1] 张海[1] 李俊[1] 郑知非[1] 

机构地区：[1]上海交通大学附属胸科医院重症监护室,上海200030

出　　处：《上海医学》2013年第11期948-953,共6页Shanghai Medical Journal

摘　　要：目的回顾性分析导致主动脉夹层患者围术期死亡的高危因素。方法收集2004-2010年心外科监护室收治的70例主动脉夹层患者,男58例,女12例;根据Stanford分型法,A型夹层37例,B型夹层33例;单纯保守治疗17例(保守治疗组),手术治疗29例(手术组),支架治疗24例(介入组)。收集所有患者治疗前后的临床资料进行分析。结果手术组顺利出院23例,死亡6例,术后发生各类并发症19例;介入组顺利出院23例,死亡1例;保守治疗组顺利出院10例,死亡7例。治疗方式(P=0.117)和手术方式(P=0.125)与Stanford A型夹层患者的预后无关联。治疗方式与Stanford B型夹层患者的预后有关联(P=0.013),行支架植入术的时间与Stanford B型夹层患者的预后无关联(P=0.583)。多因素分析显示,围术期因循环不稳定而行心肺复苏(P=0.009)、病变累及肾动脉(P=0.015)、瘤体直径≥5cm(P=0.005)和合并多器官功能衰竭(MOF,P=0.007)是导致主动脉夹层患者死亡的危险因素。结论围术期因循环不稳定而行心肺复苏、病变累及肾动脉、瘤体直径≥5cm和合并MOF是主动脉夹层患者围术期死亡的危险因素。Objective To retrospectively analyze the risk factors that may cause death in patients with aortic dissection （AD） during perioperative period. Methods A retrospective analysis was conducted in 70 AD patients who were hospitalized in cardiac surgery between 2004 and 2010. There were 58 males and 12 females. According to Stanford classification, there were 37 cases with type A and 33 with type B. Surgery was performed in 29 patients, interventional therapy with an intra-aortic stent in 24 patients and conservative treatment in 17 patients. Clinical data of patient before and after treatment were recorded and analyzed. Results Six patients died after surgery, one died after endovascular stent grafting, and 7 died during conservative treatment. Complications occurred in 19 patients after surgery. Treatment therapies （P--0.117） and surgical methods （P = 0. 125） were not related to prognosis in patients with Stanford type A. Interventional therapy may improve prognosis in patients with Stanford type B （P--0. 013）, while treatment time did not affect prognosis （P = 0. 583）. Multiple factor analysis showed that hemodynamic compromise （P = 0. 009）, renal artery involvement （ P = 0.0 ] 5）, diameter of dissecting aneurysm above 5 cm （ P = 0. 005） and multiple organ failure （MOF） after surgery （P = 0. 007） were the main risk factors of death in AD patients. Conclusion Hemodynamic compromise, renal artery involvement, large dissecting aneurysm （diameter^5 cm）, and MOF were the risk factors of death in AD patients. （Shanghai Med J, 2013, 36： 948-953）

关 键 词：主动脉 夹层动脉瘤 预后 高危因素 

分 类 号：R654.3[医药卫生—外科学]