胸主动脉腔内修复术后全身炎症反应综合征的危险因素分析  

Analysis of risk factors for systemic inflammatory response syndrome after thoracic endovascular aortic repair

作　　者：向军[1] 何玲[2] 李东林 彭泰峦[1] 魏蜀亮[1] XIANG Jun;HE Ling;LI Donglin;PENG Tailuan;WEI Shuliang(Department of Cardiovascular Surgery,Affiliated Hospital of North Sichuan Medical College,Nanchong,Sichuan,637000,China;Department of Paediatrics,Affiliated Hospital of North Sichuan Medical College)

机构地区：[1]川北医学院附属医院心脏大血管外科,四川南充637000 [2]川北医学院附属医院儿科

出　　处：《临床心血管病杂志》2021年第5期468-472,共5页Journal of Clinical Cardiology

摘　　要：目的:探讨胸主动脉腔内修复(TEVAR)术后全身炎症反应综合征(SIRS)的相关危险因素,及SIRS的管理策略。方法:连续收集2013年2月—2019年10月川北医学院附属医院心脏大血管外科251例Stanford B型急性主动脉综合征(AAS)患者的临床资料,其中男187例,女64例;所有患者均在全麻介入下行TEVAR手术,按照术后是否发生SIRS分为SIRS组和非SIRS组,分别记录2组患者术前、术中相关指标及术后并发症;将单因素分析具有统计学意义的变量进行多因素Logistic回归分析,进一步明确TEVAR术后SIRS的危险因素;同时比较2组患者并发症情况。结果:TEVAR术后SIRS发生率约为31.47%。多因素分析结果显示:糖尿病史(OR=2.036,95%CI:1.019~3.254,P=0.024)、胸腔积液(OR=1.962,95%CI:1.261~5.037,P=0.018)、术前中性粒细胞/淋巴细胞比值(NLR)(OR=2.841,95%CI:0.951~2.685,P=0.009)、D-二聚体(OR=3.128,95%CI:1.024~4.392,P=0.013)、降主动脉直径(OR=1.869,95%CI:0.793~5.174,P=0.031)是TEVAR术后SIRS的独立危险因素。SIRS组患者术后肺损伤(24.1%∶5.8%,P<0.001)、肺部感染(30.4%∶11.6%,P<0.001)、二次气管插管(6.3%∶1.2%,P=0.021)、气管切开(3.8%∶0.6%,P=0.002)发生率明显增高,机械通气时间[(7.51±4.38)h∶(3.43±2.71)h,P<0.001]、术后ICU停留时间[(3.18±2.95)d∶(1.32±1.15)d,P<0.001]、住院时间[(12.31±8.51)d∶(9.15±8.46)d,P=0.006]均明显延长,院内死亡率(6.3%∶1.2%,P=0.021)增加。结论:TEVAR术后SIRS发生率较高,糖尿病史、胸腔积液、术前NLR、D-二聚体、降主动脉直径是TEVAR术后SIRS的独立危险因素。SIRS与术后肺部并发症发生率、死亡率增加及住院时间延长显著相关。因此,应更加注重TEVAR术后SIRS的危险因素,针对危险因素优化治疗策略以减少SIRS的发生以改善预后。Objective:To analyze the independent risk factors and complications for systemic inflammatory response syndrome(SIRS)after thoracic endovascular aortic repair(TEVAR)and investigate the management strategy of SIRS.Methods:There were 251 cases of patients with type Stanford B acute aortic syndrome(AAS)underwent operation in this study,including187 male and 64 female.All the patients underwent TEVAR under general anesthesia.According to whether had SIRS,patients were divided into 2 groups:SIRS goup and non-SIRS group.Univariate and logistic regression analysis were used to identify the independent risk factors.The perioperative complications were also recorded.Results:The incidence of SIRS after TEVAR was about 31.47%.The history of diabetes(OR=2.036,95%CI:1.019-3.254,P=0.024),pleural effusion(OR=1.962,95%CI:1.261-5.037,P=0.018),neutrophil/lymphocyte ratio(OR=2.841,95%CI:0.951-2.685,P=0.009),D-dimer(OR=3.128,95%CI:1.024-4.392,P=0.013),descending aorta diameter(OR=1.869,95%CI:0.793-5.174,P=0.031)were the independent risk factors for SIRS after TEVAR.The incidence rate of postoperative pulmonary failure(24.1%vs.5.8%,P<0.001),pulmonary infection(30.4%vs.11.6%,P<0.001),re-intubation(6.3%vs.1.2%,P=0.021)and tracheotomy(3.8%vs.0.6%,P=0.002)in SIRS group were significantly increase.The duration of mechanical ventilation[(7.51±4.38)hours vs.(3.43±2.71)hours,P<0.001],ICU stay time[(3.18±2.95)days vs.(1.32±1.15)days,P<0.001]and hospitalization time[(12.31±8.51)days vs.9.15±8.46)days,P=0.006]were significantly prolonged.The perioperative mortality(6.3%vs.1.2%,P=0.021)was significantly increased.Conclusion:The history of diabetes,pleural effusion,neutrophil/lymphocyte ratio,D-dimer,descending aorta diameter were the independent risk factors for postoperative SIRS after TEVAR.The perioperative complications in SIRS group were significantly increased.

关 键 词：急性主动脉综合征 胸主动脉腔内修复术 全身炎症反应综合征 危险因素 

分 类 号：R543[医药卫生—心血管疾病]