急性A型主动脉夹层患者术前凝血因子活性R降低或增加术后神经系统并发症发生风险  

The reduction of coagulation factor activity R before surgery increases the risk of postoperative neurological complications in patients with acute type A aortic dissection

作　　者：郎群 李轶江 彭昊 简锴陶 LANG Qun;LI Yijiang;PENG Hao;JIAN Kaitao(Department of Cardiovascular Surgery,Shenzhen Hospital,The Third School of Clinical Medicine,Southern Medical University,Shenzhen,518000,Guangdong,P.R.China;Department of Cardiovascular Surgery,Shanghai Delta Hospital,Shanghai,201702,P.R.China)

机构地区：[1]南方医科大学深圳医院心血管外科,南方医科大学第三临床医学院,广东深圳518000 [2]上海德达医院心血管外科,上海201702

出　　处：《中国胸心血管外科临床杂志》2021年第7期792-795,共4页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

摘　　要：目的分析急性A型主动脉夹层患者急诊手术术后神经系统并发症的相关危险因素。方法回顾性分析2018年10月至2019年5月我院收治的51例急性Stanford A型主动脉夹层患者资料,其中男37例(72.5%)、女14例(27.5%),年龄29~85(55.1±12.3)岁。将患者分为N1组(n=12,急诊手术后出现脑神经系统功能并发症)和N0组(n=39,急诊手术后未出现脑神经系统功能并发症),分析比较两组患者的临床资料。结果两组患者在年龄[(62.6±11.2)岁vs.(51.7±11.4)岁,P=0.003]、术前D-二聚体[(21.7±9.2)μg/L vs.(10.8±10.7)μg/L,P=0.001]、气管插管时间[(78.7±104.0)min vs.(19.6±31.8)min,P=0.003]、住ICU时间[(204.1±154.8)min vs.(110.8±139.9)min,P=0.037]、术前凝血因子活性R(4.0±1.5 vs.5.1±1.6,P=0.022)方面差异有统计学意义。术前凝血因子活性R为急诊术后出现神经系统并发症的独立危险因素(OR=2.013,95%CI 1.008~4.021,P=0.047)。结论针对急性主动脉夹层急诊术前凝血因子活性R降低的患者,建议采取更加积极的脑保护措施,减少急性主动脉夹层患者术后神经系统并发症的发生,提高生活质量。Objective To analyze the risk factors for neurological complications after emergency surgery of acute type A aortic dissection.Methods The clinical data of 51 patients with acute Stanford type A aortic dissection who were admitted to Shanghai Delta Hospital from October 2018 to May 2019 were retrospectively analyzed.There were 37 males(72.5%)and 14 females(27.5%),aged 29-85(55.1±12.3)years.The patients were divided into two groups,including a N1 group(n=12,patients with postoperative neurological insufficiency)and a N0 group(n=39,patients without postoperative neurological insufficiency).The clinical data of the two groups were compared and analyzed.Results There were statistical differences in age(62.6±11.2 years vs.51.7±11.4 years,P=0.003),preoperative D-dimer(21.7±9.2μg/L vs.10.8±10.7μg/L,P=0.001),tracheal intubation time(78.7±104.0 min vs.19.6±31.8 min,P=0.003),ICU stay time(204.1±154.8 min vs.110.8±139.9 min,P=0.037)and preoperative coagulation factor activity R(4.0±1.5 vs.5.1±1.6,P=0.022).Preoperative coagulation factor activity R was the independent risk factor for neurological insufficiency after emergency(OR=2.013,95%CI 1.008-4.021,P=0.047).Conclusion For patients with pre-emergent acute aortic dissection who are older(over 62.6-64.5 years),with reduced coagulation factor R(less than 4.0),it is recommended to take more active brain protection measures to reduce the occurrence of postoperative neurological complications in patients with acute aortic dissection,and further improve the quality of life.

关 键 词：Stanford A型主动脉夹层 神经系统并发症 急诊手术 凝血因子活性R 

分 类 号：R654.3[医药卫生—外科学]