影响A型主动脉夹层患者术后苏醒的原因分析  

Analysis of the causes affecting postoperative recovery of patients with type A aortic dissection

作　　者：高晓天 鲁成昊 余春辉 葛圣林[1] 张成鑫[1] 孙立忠[2] 董松波[2] Gao Xiaotian;Lu Chenghao;Yu Chunhui(Dept of Cardiovascular Surgery,The First Affiliated Hospital of Anhui Medical University,Hefei 230022)

机构地区：[1]安徽医科大学第一附属医院心脏大血管外科,合肥230022 [2]首都医科大学附属北京安贞医院,北京100029

出　　处：《安徽医科大学学报》2020年第10期1625-1628,共4页Acta Universitatis Medicinalis Anhui

基　　金：公益性行业科研专项项目(编号:201402009)。

摘　　要：目的分析探讨A型主动脉夹层患者术后苏醒不全影响因素。方法选择经手术治疗A型主动脉夹层共88例患者作为研究对象,根据术后苏醒评估分为术后苏醒不全组(n=52)和术后苏醒完全组(n=36)。回顾性分析两组患者的体质指数、体外循环时间、升主动脉阻断时间、深低温停循环时间、术中脑氧饱和度、高血压病史以及发病24 h内手术治疗时机。结果经单因素分析表明,两组患者的对比中,体质指数(P=0.002)、体外循环时间(P<0.001)、升主动脉阻断时间(P<0.001)、深低温停循环时间(P<0.001)、高血压病史(P=0.024)、发病24 h内行手术(P=0.006)以及术中脑氧饱和度(P<0.001)的差异有统计学意义。对于单因素分析中具有统计学意义的指标再予以二项分类因变量Logistic回归分析,结果表明,体外循环时间(OR=1.150,P=0.001)、深低温停循环时间(OR=1.450,P=0.001)、术中脑氧饱和度(OR=0.918,P=0.002)、高血压病史(OR=0.682,P=0.015)以及发病24 h内手术(OR=0.525,P=0.020)是具有统计学意义的独立预测因素。结论体外循环时间、深低温停循环时间、术中脑氧饱和度、高血压病史以及发病24 h内手术是影响A型夹层术后患者苏醒的独立预测因素。Objective To analyze the influencing factors of postoperative incomplete recovery in patients with type A aortic dissection. Methods A total of 88 patients with type A aortic dissection treated surgically in our depart-ment from January 2018 to November 2019 were selected as the study subjects. According to the postoperative recovery assessment,they were divided into the postoperative incomplete recovery group( n = 52) and the postoperative complete recovery group( n = 36). The body mass index( BMI),extracorporeal circulation( CPB) time,ascending aorta occlusion time,deep hypothermia cycle arrest time,intraoperative cerebral oxygen saturation,history of hypertension,and surgical treatment timing within 24 hours of onset were retrospectively analyzed. Results Univariate analysis showed that there were statistically significant differences in body mass index( P = 0. 002) and CPB time( P < 0. 001),time of ascending aorta occlusion( P < 0. 001),deep and low temperature shutdown cycle time( P < 0. 001),history of hypertension( P = 0. 024),surgery within 24 hours of onset( P = 0. 006),and intraoperative brain oxygen saturation( P < 0. 001). For the single factor analysis indicators to be statistically significant in two classifications dependent variable Logistic regression analysis,the results showed that extracorporeal circulation time( OR = 1. 150,P = 0. 001),the cycle time of cryogenic stop( OR = 1. 450,P = 0. 001),brain oxygen saturation( OR = 0. 918,P = 0. 002),hypertension( OR = 0. 682,P = 0. 015),and within 24 hours of surgery( OR = 0. 525,P = 0. 020) were statistically significant independent predictors. Conclusion Extracorporeal circulation time,deep hypothermia shutdown time,intraoperative cerebral oxygen saturation,history of hypertension,and surgery within 24 hours of onset were independent predictors of patients’ recovery after type A dissection.

关 键 词：A型主动脉夹层 手术治疗 苏醒 原因分析 

分 类 号：R654.3[医药卫生—外科学]