Stanford A型主动脉夹层行全弓置换术后早期死亡危险因素分析  

Risk factors analysis for early operative death after total arch replacement for Stanford type A aortic dissection

作　　者：姜鑫 赵悦 文增瑞 蔡茗 葛建军 周正春 左逸 程光存 Jiang Xin;Zhao Yue;Wen Zengrui;Cai Ming;Ge Jianjun;Zhou Zhengchun;Zuo Yi;Cheng Guangcun(Department of Cardiovascular Surgery,Provincial Hospital Affiliated to Anhui Medical University,Hefei 230001,China)

机构地区：[1]安徽医科大学附属省立医院心脏大血管外科,合肥230001 [2]安徽医科大学附属省立医院胸外科,合肥230001 [3]安徽医科大学附属省立医院普外科,合肥230001 [4]徐州医科大学附属医院麻醉科,徐州221000

出　　处：《中国体外循环杂志》2020年第6期370-374,共5页Chinese Journal of Extracorporeal Circulation

基　　金：安徽省重点研究与开发计划(202004j07020018)。

摘　　要：目的探讨分析急性Stanford A型主动脉夹层(ATAAD)患者行全弓置换术后早期死亡的危险因素。方法回顾性分析2016年12月至2020年5月在安徽医科大学附属省立医院心脏大血管外科行全弓置换的ATAAD患者的临床资料。根据术后30 d(包括30 d)是否发生死亡分为死亡组(n=14)与存活组(n=144),并收集两组患者围手术期各项指标,进行多因素logistic分析影响术后早期死亡的危险因素。结果与存活组相比,死亡组术前肾功能异常及术后二次插管、肝损伤、肾脏替代治疗的比例均更高(P<0.05);此外,死亡组术中主动脉阻断时间更长(P<0.05);多因素logistic回归分析显示:主动脉阻断时间(OR=1.056,95%CI:1.005~1.109)、二次插管(OR=4.974,95%CI:1.079~22.925)、肾脏替代治疗(OR=6.197,95%CI:1.189~32.290)是ATAAD患者术后30 d死亡的独立危险因素。结论主动脉阻断时间、术后二次插管及肾脏替代治疗是ATAAD患者行全弓置换术后早期死亡的危险因素。Objective To explore the risk factors of early operative death after total arch replacement in Stanford type A aortic dissection.Methods From December 2016 to May 2020,the total of 158 patients with Stanford type A aortic dissection who underwent total arch replacement in our center were collected and analyzed.The patients were divided into two groups by clinical outcome at 30 days after the operation(death group n=14,survival group n=144).The perioperative indexes and the early postoperative risk factors for death were collected and analyzed by multivariate logistic analysis.Results The proportion of abnormal renal function,postoper⁃ative reintubation,liver damage and renal replacement therapy in death group were significantly higher than those in survival group(P<0.05),in addition,the aortic cross-clamp time was significantly longer in death group(P<0.05).Multivariable logistic regression analysis showed that aortic cross-clamp time(OR=1.056,95%CI:1.005-1.109),reintubation(OR=4.974,95%CI:1.079-22.925),renal replacement therapy(OR=6.197,95%CI:1.189-32.290)were significantly associated with 30-days mortality.Conclusion Aortic cross-clamp time,reintubation and renal replacement therapy are independent risk factors for early op⁃erative death after total arch replacement in Stanford type A aortic dissection.

关 键 词：主动脉夹层 全弓置换 危险因素 心肺转流 心肌损伤 二次气管插管 肾脏替代治疗 

分 类 号：R654.3[医药卫生—外科学]