影响Stanford A型主动脉夹层术后加速康复的危险因素分析  

Analysis of risk factors for accelerated recovery after Stanford A aortic dissection

作　　者：宋先荣[1] 张子涵 李金红[1] 孟丽[1] 张婉真[1] 韩晓丽[1] 刘玉梦 郭琛烨 SONG Xianrong;ZHANG Zihan;LI Jinhong;MENG Li;ZHANG Wanzhen;HAN Xiaoli;LIU Yumeng;GUO Chenye(Department of Critical Care Medicine,Henan Provincial Chest Hospital,Zhengzhou 450003,China)

机构地区：[1]河南省胸科医院重症医学科,450003

出　　处：《心肺血管病杂志》2021年第10期1046-1049,共4页Journal of Cardiovascular and Pulmonary Diseases

摘　　要：目的:探讨影响Stanford A型主动脉夹层术后加速康复的危险因素,建立相应的预防和干预措施。方法:回顾性分析河南省胸科医院心脏外科2016年12月至2019年1月,连续收治的199例Stanford A型主动脉夹层手术患者的临床资料(其中148例为急诊手术)。以ICU滞留时间延长作为观察指标(ICU滞留时间延长定义为ICU停留超过7 d),将其可能危险因素纳入单因素分析,单因素分析有意义的变量纳入多因素Logistic回归分析。统计得出影响ICU滞留时间的危险因素。ICU滞留时间≥7 d为非加速康复组,ICU滞留时间<7 d为加速康复组。结果:围术期病死率7.5%(15/199),ICU滞留平均4.81 d,38例超过7 d。Logistic回归结果显示:年龄、肥胖、急诊手术、深低温停循环时间、肾功能不全、大量输血、低氧血症、谵妄为ICU滞留延长的危险因素。结论:影响Stanford A型主动脉夹层术后加速康复的因素多,做好围术期管理,及时发现高危患者,采取相应的干预措施,对于降低ICU留观时间、加速康复和提高手术效果具有十分重要的意义。Objective:To explore the independent risk factors for the accelerated recovery after Stanford A aortic dissection and establish corresponding prevention and intervention measures.Methods:The clinical data of 199 consecutive patients with Stanford A aortic dissection(including 148 cases of emergency operation)in the department of cardiac surgery of Henan Provincial Chest Hospital from December 2016 to January 2019 were retrospectively analyzed.Prolonged ICU residence time was taken as the observation indicator(Prolonged ICU residence time was defined as the ICU stay for more than 7 days).The possible risk factors were included in univariate analysis,and the significant variables in univariate analysis were included in multivariate logistic regression analysis.The independent risk factors for ICU residence time were obtained.The patients with ICU residence time greater than or equal to 7 days were classified as non-accelerated recovery group while those with ICU residence time less than 7 days were classified as accelerated recovery group.Results:The perioperative mortality was 7.5%(15/199)and the average ICU residence time was 4.81 days,with 38 cases over 7 days.Logistic regression showed that age,obesity,emergency operation,deep hypothermic circulatory arrest time,renal insufficiency,massive blood transfusion,hypoxemia and delirium were independent risk factors for prolonged ICU residence time.Conclusions:There are many factors affecting the accelerated recovery after Stanford A aortic dissection.Good perioperative management,timely detection of high-risk patients and corresponding intervention measures are of great significance for reducing ICU observation time,accelerating recovery and improving surgical effect.

关 键 词：STANFORDA型主动脉夹层 加速康复 危险因素 

分 类 号：R54[医药卫生—心血管疾病]