急性A型主动脉夹层患者术前低氧血症的危险因素分析及预后研究  

Risk Factors and Prognosis of Preoperative Hypoxemia in Patients with Type A Acute Aortic Dissection

作　　者：王维[1] 张森[1] 于明港 孙晓刚[1] 于存涛[1] 陈祖君[1] 张海涛[1] WANG Wei;ZHANG Sen;YU Ming-gang;SUN Xiao-gang;YU Cun-tao;CHEN Zu-jun;ZHANG Hai-tao(Department of Cardiovascular Surgery,Fuwai Hospital,National Center for Cardiovascular Diseases,Chinese Academy of Medical Sciences&Peking Union Medical College,Beijing 100037,China)

机构地区：[1]中国医学科学院北京协和医学院国家心血管病中心阜外医院心外科,北京市100037

出　　处：《中国分子心脏病学杂志》2020年第3期3371-3373,共3页Molecular Cardiology of China

摘　　要：目的采用临床大样本数据分析术前低氧血症相关的危险因素及预后。方法采集中国医学科学院阜外医院2016年10月至2019年10月期间手术的310例急性Stanford A型主动脉夹层患者的病例资料,包括性别、年龄、体重指数、是否伴有高血压、糖尿病、吸烟史、慢性阻塞性肺疾病、心脏射血分数,以及重要实验室检查如白细胞计数、C反应蛋白、D-二聚体,以及ICU停留时间。低氧血症定义为氧合指数低于150(动脉氧分压/吸入氧浓度<150,Pa02/Fi02<150)。采用单因素比较、多因素线性回归分析患者一般情况及实验室检查各项指标与低氧血症的相关性。结果无低氧血症组121例,6例死亡;低氧血症组189例,死亡12例,两组患者年龄、性别、高血压史、糖尿病史、慢性阻塞性肺疾病、心脏射血分数,无统计学意义(P>0.05),ICU停留时间有统计学意义(P<0.05);单因素分析与发生低氧血症相关的因素包括:体重指数[(28.11±3.18)kg/m^2 vs(22.16±3.42)kg/m^2,P<0.05];吸烟史(58例vs 32例,P<0.05);白细胞计数[(13.34±2.75)×10^9/L vs(9.19±2.18)×10^9/L,P<0.05];C反应蛋白浓度(19.42 mg/L vs 13.14 mg/L,P<0.05);D-二聚体浓度(4.92μg/ml vs 1.78μg/ml,P<0.05)。多因素线性回归分析与发生低氧血症相关的因素为:C反应蛋白浓度(B:-9.25,95%CI:-12.33^-0.92,P=-0.039)。多因素Logistic回归分析低氧血症的独立危险因素包括:体重指数(OR:2.13,95%CI:1.25^1.89)、吸烟史(OR:3.01,95%CI:1.77^5.24)。结论本研究发现急性主动脉夹层术前低氧血症停留时间更长,体重指数及吸烟史为低氧血症的独立危险因素,急性主动脉夹层患者的C反应蛋白浓度与氧合指数之间存在显著相关性。Objective To clarify risk factors of hypoxemia in a large set of samples with acute aortic dissection.Methods A retrospective analysis of patients with acute aortic dissection,from November 2016 to November 2019 in Fuwai Hospital,including gender,age,body mass index(BMI),associating with hypertension,diabetes,chronic obstructive pulmonary disease,ICU time,as well as the laboratory examination:count of white blood cell,C reactive protein(CRP),D-dimer.Hypoxemia is defined as the oxygenation index less than 150(Pa02/Fi02<150).Univariate analysis was used.Results 310 patients were enrolled in this study.No-hypoxemia group had 121 cases,including 6 operation patients death.Hypoxemia group hasd 189 cases,including 12 operation patients death.There was no significant difference in age,gender,hypertension,diabetes mellitus,cardiac ejection fraction.There is statistically significant in ICU time.Univariate analysis found risk factors for hypoxemia include:body mass index([28.11±3.18]kg/m2 vs[22.16±3.42]kg/m2,P<0.05);history of smoking(58 vs 32 cases,P<0.05);white blood cell count([13.34±2.75]×10^9/L vs[9.19±2.18]×10^9/L,P<0.05);CPR(19.42 mg/L vs 13.14 mg/L,P<0.05));D-dimer(4.92μg/ml vs 1.78μg/ml,P<0.05).Multivariate linear regression of related fctors for hypoxemia was:CPR(B:-9.25,95%CI:-12.33^-0.92,P=0.039).Logistic analysis of independent risk factors includes:bodymass index(OR:2.13,95%CI:1.25-1.89),history of smoking(OR:3.01,95%CI:1.77^5.24).Conclusion BMI and smoking history are independent risk factors for hypoxemia,abnormal of systemic inflammation may be associated with impaired lung function.Assessment of the clinical risk factors can guide treatment and reducing the occurrence of related complications.

关 键 词：急性A型主动脉夹层 低氧血症 危险因素 C反应蛋白 

分 类 号：R654.3[医药卫生—外科学]