急性A型主动脉夹层孙氏术后低氧血症的相关因素分析  

Risk factors for hypoxemia after Sun’s procedure for acute Stanford A aortic dissection

作　　者：于子翔 潘旭东[1] 董松波[1] 张凯 朱凯 高慧强[1] 郑军[1] 孙立忠[1] YU Zixiang;PAN Xudong;DONG Songbo;ZHANG Kai;ZHU Kai;GAO Huiqiang;ZHENG Jun;SUN Lizhong(Beijing Aortic Disease Center,Beijing Anzhen Hospital,Capital Medical University,Beijing Institute of Heart,Lung and Blood Vessel Diseases,Beijing 100029,China)

机构地区：[1]首都医科大学附属北京安贞医院-北京市心肺血管病研究所,北京市大血管疾病诊疗中心,100029

出　　处：《心肺血管病杂志》2020年第6期711-715,共5页Journal of Cardiovascular and Pulmonary Diseases

摘　　要：目的:探讨急性A型主动脉夹层孙氏术后低氧血症发生的相关危险因素。方法:回顾性分析首都医科大学附属北京安贞医院,2018年1月至2018年12月,连续收治的209例急性A型主动脉夹层行孙氏手术患者的临床资料。男性172例,女性37例;平均年龄(47.4±10.1)岁;发病到手术时间<14 d。根据术后是否发生低氧血症,将209例患者分为低氧血症组[PaO2/吸入氧浓度(FiO2)<200 mmHg,1 mmHg=0.133 kPa]和非低氧血症组(PaO2/FiO2≥200 mmHg)。分析和比较两组患者的围术期相关资料,采用多因素Logistic回归分析急性主动脉夹层患者术后发生低氧血症的危险因素。结果:术后低氧血症的发生率56.9%(119/209),围术期死亡20例(9.6%,其中低氧血症组13例,非低氧血症组7例)。单因素分析结果:两组患者发病到手术时间(h)、发病到手术时间>24 h、术前ALT、Cr、BMI差异有统计学意义(P<0.05);低氧血症组呼吸机辅助通气时间、重症监护病房(ICU)滞留时间多于非低氧血症组,差异有统计学意义(P<0.05)。多因素回归分析结果显示:BMI、发病到手术时间>24 h是急性A型主动脉夹层孙氏术后低氧血症的危险因素。结论:低氧血症是急性A型主动脉夹层孙氏术后常见的并发症,肥胖、发病到手术时间>24 h是急性A型主动脉夹层孙氏术后低氧血症的危险因素,针对性地给予干预措施,以降低低氧血症发生率,从而改善患者的预后。Objective:To explore the risk factors for postoperative hypoxemia after Sun’s procedure for acute Stanford A aortic dissection.Methods:We retrospectively analyzed clinical data of 209 consecutive patients with acute Stanford A aortic dissection who received Sun’s procedure surgery in Beijing Anzhen Hospital from January 2018 to December 2018.Of them,172 men vs.37 women,age(47.4±10.1)years old.The operation was performed within 14 days since disease onset.According to whether they had postoperative hypoxemia,all the 209 patients were divided into hypoxemia group[arterial partial pressure of oxygen(PaO2)/fraction of inspired oxygen(FiO2)<200 mmHg,1 mmHg=0.133 kPa]and non-hypoxemia group(PaO2/FiO2≥200 mmHg).Perioperative clinical data were analyzed and compared between the two groups.Multivariate Logistic regression was performed to identify risk factors of postoperative hypoxemia after Sun’s procedure surgery for acute Stanford A aortic dissection.Results:The incidence of postoperative hypoxemia was 56.9%(119/209).Perioperative death occurred in 20 patients(9.6%,including 13 patients in hypoxemia group and 7 patients in non-hypoxemia group).Univariate analysis showed that,the time of disease onset to operation、the time of disease onset to operation>24 h、BMI,ALT,Cr were statistically significant.Mechanical ventilation duration,duration of intensive care unit(ICU)stay in hypoxemia group were longer than those in non-hypoxemia group(P<0.05).Logistic multivariate regression identified that BMI and the time of onset to operation>24 h were independent risk factors of postoperative hypoxemia after Sun’s procedure for acute Stanford A aortic dissection.Conclusions:Postoperative hypoxemia is a common complication.after Sun′s procedure for acute Stanford A aortic dissection.Obesity and the time of disease onset to operation>24 h were independent risk factors of postoperative hypoxemia after Sun’s procedure for acute Stanford A aortic dissection.Interventions should be pay to these factors to reduce the inc

关 键 词：急性A型主动脉夹层 孙氏手术 低氧血症 相关因素 

分 类 号：R54[医药卫生—心血管疾病]