Stanford B型主动脉夹层术前发生低氧血症的危险因素分析  

Risk factors analysis for preoperative hypoxemia in patients with Stanford Type B aortic dissection

作　　者：买买提艾力·艾则孜[1] 庞秀慧[2] 杜宇奎 张为民[1] 张立[4] 何亮[4] 阿依别克·乃比[1] 郭盛[1] 郭永忠[1] 刘筠[1] 张总刚[1] 杨秀滨 唐和年[1] 

机构地区：[1]新疆维吾尔自治区人民医院心外科,新疆乌鲁木齐市830001 [2]新疆维吾尔自治区人民医院临床检验中心,新疆乌鲁木齐市830001 [3]中国医学科学院阜外医院血管外科中心 [4]新疆维吾尔自治区人民医院麻醉科,新疆乌鲁木齐市830001

出　　处：《中国心血管病研究》2017年第9期824-829,共6页Chinese Journal of Cardiovascular Research

摘　　要：目的 研究Stanford B型主动脉夹层术前发生低氧血症的独立危险因素,并建立相应的风险预测模型.方法 回顾性分析新疆维吾尔自治区人民医院心脏外科2004年1月至2016月2月连续收治的200例Stanford B型主动脉夹层患者临床资料,根据患者氧合指数即PaO2/FiO2≤200 mm Hg分为低氧血症组和非低氧血症组,对潜在的危险因素进行单因素分析筛选以及后续二分类Logistic回归分析,利用得到的独立危险因素建立预测模型.结果 Stanford B型主动脉夹层患者术前发生低氧血症41例,发生率20.5％.单因素分析显示,患者左室收缩期末径、主动脉前向流速、超敏C反应蛋白（hs-CRP）、总蛋白素（TBIL）、直接胆红素（DBIL）、间接胆红素（IBIL）,血清总蛋白（TP）、血清白蛋白（ALB）、血清乳酸脱氢酶（LDH）、全血血小板计数（PLT）、全血中性粒细胞百分比（NEUT％）对Stanford B型主动脉夹层术前发生低氧血症有影响.二分类Logistic回归分析显示,TBIL是Stanford B型主动脉夹层发生低氧血症的独立危险因素（OR=1.038,95％CI1.003～1.075,P=0.031）,TP为保护性因素（OR =0.941,95％CI 0.893～0.991,P=0.022）.结论 Stanford B型主动脉夹层术前发生低氧血症率高,TBIL是Stanford B型主动脉夹层发生低氧血症的独立危险因素,TP为保护性因素.Objective To investigate the risk factors for hypoxemia in preoperative Stanford Type A aortic dissection.Methods From January 2004 to February 2016,clinical data of 200 consecutive patients with Stanford Type B aortic dissection were retrospectively analyzed.Preoperative hypoxemia was defined as the arterial partial oxygen over inspired oxygen fraction （PaO2/FiO2） more than 200 mm Hg,potential risk factors were screened out by univariate analysis between hypoxemia group and non-hypoxemia group,then independent risk factors were identified by binary logistic regression analysis.The prediction model was established upon acquired independent risk factor.Results 41 case of hypoxemia were induced by preoperative Stanford Type B aortic dissection,incidence of 20.5%.Univarite analysis showed that Left ventricular end systolic diameter,aortic forward velocity,high sensitive C reactive protein （hs-CRP）,total protein （TBIL）,direct bilirubin （DBIL）,indirect bilirubin（IBIL）,serum total protein （TP）,serum albumin （ALB）,serum lactate dehydrogenase （LDH）,serum blood platelet count （PLT）,whole blood neutrophil percentage （NEUT%） were risk factors for hypoxemia with preoperative Stanford Type B aortic dissection.Binary logistic regression analysis showed TBIL was independent risk factors for hypoxemia in preoperative Stanford Type B aortic dissection （OR=1.038,95%CI 1.003-1.075,P=0.031）,TP was protective factors（OR=0.941,95%CI 0.893-0.991,P=0.022）.Conclusion There is a high proportion of hypoxemia in preoperative Stanford Type B aortic dissection.TBIL is independent risk factors for hypoxemia in preoperative Stanford Type B aortic dissection,TP indicates as protective factors.

关 键 词：主动脉夹层 低氧血症 危险因素 

分 类 号：R654.2[医药卫生—外科学]