急性A型主动脉夹层术前低氧血症危险因素分析  

Risk factors for preoperative hypoxemia in acute type A aortic dissection

作　　者：段旭洲 陈佳[2] 徐志云[1] 

机构地区：[1]第二军医大学长海医院胸心外科,上海200433 [2]第二军医大学长征医院心内科,上海200003

出　　处：《第二军医大学学报》2016年第1期111-114,共4页Academic Journal of Second Military Medical University

基　　金：国家高技术研究发展计划("863"计划;2009AA02Z401)~~

摘　　要：目的探讨急性A型主动脉夹层患者术前低氧血症的危险因素。方法收集第二军医大学长海医院2013年1月至2014年5月收治的70例急性A型主动脉夹层患者的临床资料。将低氧血症定义为静态吸氧状态下,术前氧合指数(PaO2/FiO2)≤200。根据此定义,将患者分为低氧血症阳性组(n=21)和低氧血症阴性组(n=49)。通过差异性检验和logistic回归模型分析术前低氧血症与下述指标的关系:患者的性别、年龄、体质量指数(BMI)等基本信息,吸烟、饮酒、糖尿病、高血压、冠心病等既往史,C-反应蛋白(CRP)、D-二聚体、凝血酶原时间、肌酐、B型钠尿肽(BNP)、红细胞沉降率、白介素(IL-6)、射血分数、心包腔积液、夹层撕裂范围和程度(是否累及肾动脉、肠系膜上动脉)等实验学及影像学检查数据。结果低氧血症阳性组和低氧血症阴性组在患者入院时的BMI、CRP、IL-6、D-二聚体水平、夹层撕裂范围和程度(累及肾动脉、肠系膜上动脉)等方面差异有统计学意义(P<0.05)。Logistic回归分析提示CRP、D-二聚体为术前低氧血症的独立危险因素。结论患者术前BMI、全身急性炎性反应、血液D-二聚体水平、夹层撕裂范围和程度与低氧血症存在关联性,其中CRP和D-二聚体为术前低氧血症的独立危险因素。Objective To determine the risk factors associated with preoperative hypoxemia in acute type A aortic dissection. Methods The clinical data of 70 patients undergoing surgery for acute type A aortic dissection were collected from January 2013 to May 2014. Preoperative hypoxemia was defined by an arterial partial oxygen/inspired oxygen fraction （PaO2/ FiO2 ） ratio ≤200 under static oxygen inhalation, and the patients were divided into hypoxemia group （n = 21） and non- hypoxemia group （n=49） accordingly. The following data were collected, including age, gender, body mass index, smoking, drinking, history of hypertension, diabetes mellitus, coronary disease, CRP, D-dimer, PT, ereatinine, BNP, ESR, IL-6, LVEF, pericardial effusion, the dissection involving renal artery, and mesenteric artery. The relationship between preoperative hypoxemia and the above data were analyzed by differences test and logistic regression analysis. Results We found that the body mass index, CRP, D-dimer, IL-6 and the dissection degree and involvement （renal artery and mesenteric artery） were significantly different between the hypoxemia group and non-hypoxemia group （P〈0. 05）. According to logistic regression analysis, the independent predict factors for preoperative hypoxemia included CRP and D-dimer. Conclusion Body mass index, systemic inflammatory response, blood D-dimer, and dissection degree and scope are associated with preoperative hypoxemia. And CRP and D-dimer are the independent risk factors for preoperative hypoxemia in patients with acute type A aortic dissection.

关 键 词：夹层动脉瘤 主动脉瘤 低氧血症 危险因素 

分 类 号：R654.31[医药卫生—外科学]