急性Stanford A型主动脉夹层术后ICU监护时间延长的危险因素分析  

Predictive Risk Factors for Prolonged Stay in the Intensive Care Unit after Surgery for Acute Aortic Dissection Type A

作　　者：生伟[1] 池一凡[1] 牛兆倬[1] 林明山[1] 乔友进[1] 吴建涛[1] 孙龙[1] 

机构地区：[1]青岛大学医学院附属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》2016年第5期434-439,共6页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

基　　金：青岛市卫生局课题(2014-WJZD030)~~

摘　　要：目的分析急性Stanford A型主动脉夹层术后重症监护室(ICU)监护时间延长的危险因素。方法回顾性分析青岛市市立医院2009年12月至2013年12月间80例Stanford A型主动脉夹层手术患者的临床资料,其中男54例(67.5%)、女26例(32.5%),平均年龄(48.9±12.5)岁,ICU时间延长定义为术后ICU时间≥5 d。按ICU监护时间分为两组,ICU监护时间<5 d 67例,ICU监护时间≥5 d 13例。对两组患者围术期多项指标进行单因素和多因素分析。结果 ICU监护时间<5 d和≥5 d患者的ICU监护时间分别为(63.2±17.4)h和(206.9±25.4)h,院内死亡率分别为3.0%和15.4%。单因素分析显示,ICU监护时间<5 d和≥5 d患者患者年龄、欧洲心血管手术危险因素评分、术前D-二聚体水平、体外循环时间、是否深低温停循环、正性肌力药物、术后是否发生脑卒中、术后是否发生急性肾功能衰竭和呼吸衰竭、ICU滞留时间、住院时间差异均有统计学意义。多因素分析结果显示,体外循环时间、术后是否发生脑卒中、术后是否发生急性肾功能衰竭和呼吸衰竭是ICU监护时间延长的独立危险因素。结论体外循环时间、术后发生脑卒中、急性肾功能衰竭和呼吸衰竭是急性Stanford A型主动脉夹层术后ICU监护时间延长的独立危险因素。临床上可以根据上述危险因素采取相应的预防措施,有助于缩短术后ICU监护时间。Objective To identify the predictors of prolonged stay in the intensive care unit（ICU） in patients undergoing surgery for acute aortic dissection type A.Methods We retrospectively analyzed the clinical data of 80 patients who underwent surgery for acute aortic dissection type A in Qingdao Municipal Hospital from December 2009 through December 2013.The mean age of the patients was 48.9±12.5 years,including 54 males（67.5%） and 26 females（32.5%）.The patients were divided into two groups based on their stay time in the ICU.Prolonged length of ICU stay was defined as 5 days or longer time in the ICU postoperatively.There were 67 patients with length of ICU stay shorter than 5 days,13 patients with length of ICU stay 5 days or longer time.Univariate and multivariate analysis（logistic regression） were used to identify the predictive risk factors.Results The length of ICU stay was 63.2±17.4 hours and 206.9±25.4 hours separately.Overall in-hospital mortality was 3.0% and 15.4% respectively in the two groups.In univariate analyses,there were statistically significant differences with respect to the age,the European system for cardiac operative risk evaluation（Euro SCORE）,the preoperative D-dimmer level,total cardiopulmonary bypass（CPB） time,deep hypothermic circulatory arrest（DHCA）,inotropes and occurrence of postoperative stroke,acute renal failure and acute respiratory failure,ICU stay duration and hospital stay duration between the patients with length of ICU stay shorter than 5 days and longer than 5 days.Multivariate logistic analysis showed that CPB time,occurrence of postoperative stroke,acute renal failure,or acute respiratory failure were independent predictors for prolonged ICU stay.Conclusion The incidence of prolonged ICU stay is high after surgery for acute aortic dissection type A.It can be predicted by CPB time,occurrence of postoperative stroke,acute renal failure,and acute respiratory failure were independent predictors for prolonged ICU stay.For patients with these risk fact

关 键 词：急性主动脉夹层动脉瘤 危险因素 监护 

分 类 号：R654.3[医药卫生—外科学]