建立StanfordA型主动脉夹层围手术期风险评估系统的探索  

Establishment of perioperative risk assessment system for type A aortic dissection

作　　者：宋先荣[1] 孟丽[1] 苑星[1] 扶伟[1] 曹烨[1] 李金红[1] 张婉真[1] 刘玉梦 Song Xianrong;Meng Li;Yuan Xing Fu Wei;Cao Ye;Li Jinhong;Zhang Wanzhen;Liu Yumeng(Department of Cardiovascular Surgey of Henan Provincial Chest Hospital, Zhengzhou 450003, Chin)

机构地区：[1]河南省胸科医院重症监护室,郑州450003

出　　处：《中华胸心血管外科杂志》2018年第6期350-355,共6页Chinese Journal of Thoracic and Cardiovascular Surgery

摘　　要：目的研究StanfordA型主动脉夹层术后ICU滞留时间延长的独立危险因素，建立相应的围手术期风险预测模型。方法回顾性分析河南省胸科医院心脏外科2011年9月至2016年5月连续收治的509例StanfordA型主动脉夹层手术患者的临床资料，其中急诊手术418例。通过对术后最常见并发症的相关危险因素进行具体分析，建立围手术期评估系统。以ICU滞留延长作为终点事件（ICU滞留延长定义为ICU停留超过7天），将其可能危险因素纳入单因素分析，单因素分析有意义的变量纳入多因素logistic回归分析，利用得到的独立危险因素建立预测模型，并用ROC曲线以及Hosmer-Leme-show拟合优度检验对模型进行评价。结果围手术期病死率8．64％（44／509），ICU滞留平均5．06天，98例超过7天。Logistic回归结果显示：年龄、卒中史、肥胖、急诊手术、体外循环、深低温停循环、肾功能不全、大量输血、低氧血症、肺部感染为ICU滞留延长的独立危险因素，并据此建立数学模型。预测模型ROC曲线下面积（AUC）=0．761，Hosmer-Lemeshow拟合优度检验P=0．512。结论本研究建立的logistic模型能成功预测StanfordA型主动脉夹层术后ICU滞留延长的发生风险，预测效能满意。Objective To explore the independent risk factors of the prolonged time of retention ICU after type A aortic dissection operation, to establish a corresponding perioperative risk assessment system. Methods A total of 509 consecutive patients with type A aortic dissection were enrolled in the study from September 2011 to May 2016, among which, 418 patients received emergency operation. The prolonged retention time of ICU was considered as endpoint event. A perioperative assess- ment system was established through the analysis of related risk factors of the most common complications after type A aortic dis- section operation. The possible risk factors of prolonged retention time of ICU were introduced into a single factor analysis. The meaningful variables in the single factor analysis were introduced into logistic regression analysis. The independent risk factors which were obtained from logistic regression analysis were used to establish risk prediction model, and the ROC CUl-ee and Hos- mer-Lemeshow goodness of fit test were used to evaluate the model. Results The perioperative mortality rate was 8, 64%, the prolonged retention time of ICU was 5.06 days, and 98 cases exceeded 7 days. The results of logistic regression analysis allowed that age, the history of stroke, obesity, emergency operation, cardiopulmonary bypass time, deep hypothermic circulatory arrest time, renal inadequacy, massive transfusion, hypoxemia, and pulmonary infection were the independent risk factors for pro- longed retention time of ICU. Accordingly, a mathematical model was established. The area under ROC cure for prediction model（AUC） =0. 761, Hosmer -Lemeshow goodness of fit test P =0. 512. Conclusion The logistic model established in this study can successfully predict ICU retention time after type A aortic dissection operation, and the efficacy was predicted satis- factorily.

关 键 词：STANFORD A型主动脉夹层 围手术期 风险评估系统 

分 类 号：R654.3[医药卫生—外科学]