Stanford A型主动脉夹层术后重度低氧血症临床分析  

Severe hypoxemia after Stanford A aortic dissection surgery:a clinical analysis of 162 cases

作　　者：郝智鹏 王咏 朱雨 王海龙 刘凌超 肖颖彬 HAO Zhipeng;WANG Yong;ZHU Yu;WANG Hailong;LIU Lingchao;XIAO Yingbin(Department of Cardiovascular Surgery,Cardiovascular Surgery Institute of PLA,Second Affiliated Hospital,Army Medical University(Third Military Medical University),Chongqing,400037,China)

机构地区：[1]陆军军医大学(第三军医大学)第二附属医院全军心血管外科研究所,重庆400037

出　　处：《第三军医大学学报》2020年第9期929-936,共8页Journal of Third Military Medical University

摘　　要：目的对Stanford A型主动脉夹层进行临床分析,探讨手术后重度低氧血症的危险因素。方法纳入2016年1月至2019年3月期间162例Stanford A型主动脉夹层并接受住院手术治疗的患者进行回顾性分析。患者术后72 h内氧合指数(PaO2/FiO2)≤100 mmHg为重度低氧组,PaO2/FiO2>100 mmHg为非重度低氧血症组。比较两组患者围术期临床指标,并分析重度低氧血症相关危险因素。结果患者术后重度低氧血症发生率50.6%(82/162),重度低氧血症患者机械通气时间、术后ICU时间和术后住院时间较非重度低氧血症组患者显著延长(P<0.05)。术后早期死亡率11.7%(19/162),重度低氧血症组17.1%(14/82)显著高于非重度低氧血症组6.1%(5/80)(P=0.032);多因素回归分析显示,BMI>24 kg/m2[OR=2.604,95%置信区间CI(1.055-6.427);P=0.038],术前PaO2/FiO2≤300 mmHg[OR=2.963,95%CI(1.283-6.841);P=0.011]和体外循环(cardiopulmonary bypass,CPB)时间>195 min[OR=1.007;95%CI(1.000-1.014);P<0.044]为术后重度低氧血症的独立危险因素。结论BMI>24 kg/m2、术前PaO2/FiO2≤300 mmHg、CPB时间>195 min是Stanford A型主动脉夹层术后重度低氧血症的独立危险因素。Objective To investigate the risk factors for post-operative severe hypoxemia in patients with Stanford A aortic dissection.Methods Clinical data of 162 patients with Stanford A aortic dissection undergoing surgical treatment in our hospital from January 2016 to March 2019 were collected and retrospectively analyzed in this study.According to their oxygenation index(PaO2/FiO2)within 72 h after operation,they were divided into severe hypoxia group(≤100 mmHg)and non-severe hypoxemia group(>100 mmHg).The perioperative clinical indexes were compared between the 2 groups,and the risk factors of severe hypoxemia were analyzed.Results The incidence of severe hypoxemia was 50.6%(82/162)in the cohort.The severe hypoxia group had significantly longer time of mechanical ventilation,postoperative length of ICU stay and hospital stay when compared with the non-severe hypoxia group(all P<0.05).The total mortality rate was 11.7%(19/162),with that in the severe group obviously higher than that of the other group[17.1%(14/82)vs 6.1%(5/80),P=0.032].Multivariate regression analysis showed that BMI>24 kg/m2(OR=2.604,95%CI:1.055~6.427,P=0.038),preoperative PaO2/FiO2≤300 mmHg(OR=2.963,95%CI:1.283~6.841,P=0.011)and cardiopulmonary bypass(CPB)time>195 min(OR=1.007,95%CI:1.000~1.014,P<0.044)were independent risk factors for post-operative severe hypoxemia after surgery.Conclusion BMI>24 kg/m2,preoperative PaO2/FiO2≤300 mmHg and CPB time>195 min are independent risk factors for post-operative severe hypoxemia after surgery of Stanford type A aortic dissection.

关 键 词：低氧血症 主动脉夹层 危险因素 

分 类 号：R619[医药卫生—外科学] R654.3[医药卫生—临床医学]