急性StanfordA型主动脉夹层致急性肺损伤相关危险因素分析  

Independent determinants of acute lung injury before thoracic aortic surgery for stanford type-A acute aortic dissection: acute aortic dissection—acute lung injury study

作　　者：杨彦伟[1] 金沐[1] 董秀华[1] 孙立忠[2] 王嵘[1] 林培容[1] 程怡[1] 侯思雨[1] 马月华[1] 王岳锋[1] 刘静[3] 卢家凯[1] 程卫平[1] 

机构地区：[1]首都医科大学附属北京安贞医院-北京市心肺血管研究所麻醉科,100029 [2]首都医科大学附属北京安贞医院-北京市心肺血管研究所心外科,100029 [3]首都医科大学附属北京安贞医院-北京市心肺血管研究所流行病学研究室,100029

出　　处：《心肺血管病杂志》2016年第2期124-128,共5页Journal of Cardiovascular and Pulmonary Diseases

基　　金：首都卫生发展科研专项项目(No.2011-2006-03);北京市科学技术委员会(No.Z141107002514135);中国国际科技合作计划(No.2012DFA31110);卫生公益性行业专项科研基金(No.201402009)

摘　　要：目的：识别急性Stanford A型主动脉夹层（ASAAD）术前急性肺损伤（ALI）相关危险因素之间的关系,为评估ALI严重性及探索治疗方法提供科学依据。方法：进行前瞻性单中心临床试验,选取99例进行手术治疗的ASAAD患者。干预指标选取术前临床变量和血清学的检测。主要观察指标用于评估ASAAD患者术前致ALI的独立相关危险因素。ALI以Murray肺损伤评分来定义。结果：有51.5%的患者术前发生了ALI。与术前未患ALI者相比,ALI组患者年龄较大（P=0.037）,术后机械通气持续时间较长（P=0.023）。结果显示,PLC[（193±72）vs.（165±65）ng/L,P〈0.05],IL-10[（103.4±72.7）vs.（75.1±53.9）ng/L,P〈0.05]的浓度ALI组明显低于无ALI组。血浆IL-6的浓度[（57.9±21.7）vs.（69.9±26.3）ng/L,P〈0.001）]ALI组明显高于无ALI组。多因素logistic回归分析显示,IL-6（OR=1.022;95%CI：1.001-1.004,P=0.042）和年龄（OR=1.085;95%CI：1.021-1.152,P=0.008）与术前ALI有明显相关性。在这些指标中,IL-6与术前ALI呈正相关性,其临界值为64.76ng/L。结论：以Murray肺损伤评分为标准,51.5%的患者在术前患有ALI。多因素分析显示,术前IL-6水平和年龄是ASAAD患者术前发生ALI的独立危险因素,术前患有ALI的患者年龄普遍较大。IL-6≥64.76 ng/L是非常重要的危险因素并且对于术前发生ALI的ASAAD患者有独立相关性。Objective： To identify the independent predictors of preoperative acuce lung injury（ ALI）in the Chinese adult patients undergoing Stanford type-A acute aortic dissection（ AAD） surgery. Methods： Design,Setting,and Participants A prospective signal-center clinical trial,recruited 99 adult patients undergoing Stanford type-A AAD surgery at a academic hospital in China between Jun 2013 and July 2014. Main outcome measures Perioperative clinical baselines and serum variables including inflammatory were assayed. The independent factors affecting the occurrence of preoperative ALI were identified by multiple logistic regression analyses. Results： The incidence of preoperative ALI was 51. 5%. The ALI patients were more elder（ P = 0. 037）and longer duration of postoperative mechanical ventilation（ P = 0. 023）. Furthermore,PLC[（ 193 ± 72） vs.（ 165 ± 65） ng /L,P〈0. 05]and interleukin-10（ IL-10） [（ 103. 4 ± 72. 7） vs.（ 75. 1 ± 53. 9） ng /L,P〈0. 05 ]levels were significantly lower in the ALI patients than in the non-ALI patients. Plasma interleukin-6（ IL-6） levels [（ 57. 9 ± 21. 7） vs.（ 69. 9 ± 26. 3） ng/L,P〈0. 001） ]were significantly higher in the ALI patients than in the non-ALI patients. By multiple logistic regression analysis,age and IL-6 level were significantly associated with preoperative ALI. Age and IL-6 level had positive correlations with preoperative ALI,with the cut-off values of 50. 5 years and 64. 76 ng / L respectively. Conclusion： In a representative sample of Chinese adults undergoing Stanford type-A AAD surgery,the incidence of preoperative ALI was 51. 5% and age,IL-6 were independent predictors of preoperative ALI.

关 键 词：急性主动脉夹层 急性肺损伤 危险因素 

分 类 号：R54[医药卫生—心血管疾病]