术前灌注不良综合征对急性Stanford A型主动脉夹层患者术后预后的影响  

IMPACT OF PREOPERATIVE MALPERFUSION SYNDROME ON POSTOPERATIVE PROGNOSIS OF PATIENTS WITH ACUTE STANFORD TYPE A AORTIC DISSECTION

作　　者：孙皓涵 孙振[1] 胡昊宇 杨苏民[1] 王士忠[1] SUN Haohan;SUN Zhen;HU Haoyu;YANG Sumin;WANG Shizhong(Department of Cardiac Surgery, The Affiliated Hospital of Qingdao University, Qingdao 266003, China)

机构地区：[1]青岛大学附属医院心血管外科,山东青岛266003

出　　处：《精准医学杂志》2020年第3期201-204,共4页Journal of Precision Medicine

基　　金：国家自然科学基金青年科学基金项目(81700247)。

摘　　要：目的探讨术前发生灌注不良综合征对急性Stanford A型主动脉夹层患者术后预后的影响。方法回顾性分析2016年1月—2019年4月我院心血管外科确诊的急性Stanford A型主动脉夹层患者124例,根据术前是否合并灌注不良综合征分为观察组(49例)和对照组(75例)。记录患者性别、年龄、体外循环时间、停循环时间等临床资料。比较两组患者术后二次开胸的发生率、并发症发生率及院内死亡的发生率。结果两组患者体外循环时间、停循环时间、截瘫及二次开胸手术比较差异无显著性(P>0.05)。观察组患者术后急性肾损伤、急性肝损伤、心肌梗死、脑卒中、消化道出血、感染及院内死亡的发生率均高于对照组,差异具有统计学意义(χ^2=7.459~31.044,P<0.05)。结论术前发生灌注不良综合征的急性Stanford A型主动脉夹层患者术后并发症及死亡的发生率高,预后差。因此应完善术前相关检查及脏器功能的评估,积极地手术干预发生灌注不良的脏器以改善患者术后的预后。Objective To investigate the impact of preoperative malperfusion syndrome on the postoperative prognosis in patients with acute Stanford type A aortic dissection.Methods A retrospective analysis was performed on the clinical data of 124 patients who were diagnosed with acute Stanford type A aortic dissection in the department of cardiovascular surgery in our hospital from January 2016 to April 2019.All the patients were divided into observation group(49 cases)and control group(75 cases),according to whether the patients had malperfusion before the operation or not.Demographic and clinical data including age,sex,cardiopulmonary bypass time,and circulatory arrest time were recorded.The incidence of complications,secondary thoracotomy,and hospital death were compared between the two groups.Results No significant difference was found in cardiopulmonary bypass time,deep hypothermia circulatory arrest time,or the incidence of paraplegia or secondary thoracotomy between the two groups(P>0.05).However,the observation group showed significantly higher incidence rates of acute renal injury,acute liver injury,myocardial infarction,stroke,gastrointestinal hemorrhage,infection,and hospital death than the control group(χ^2=7.459-31.044,P<0.05).Conclusion Patients with acute Stanford type A aortic dissection have a higher incidence of postoperative complications and death,and thus a poorer prognosis,when they have preoperative malperfusion syndrome.As a result,relevant examinations and organ function evaluation should be done before the surgery,and active surgical interventions are needed to protect the organs from poor perfusion and improve the prognosis of the patients.

关 键 词：动脉瘤 夹层 灌注不良综合征 血液循环 血管外科手术 手术后并发症 预后 影响因素分析 

分 类 号：R543.16[医药卫生—心血管疾病] R654.3[医药卫生—内科学]