急性Stanford A型主动脉夹层术后患者院内早期死亡危险因素分析  

Risk factors for early in-hospital death in patients with acute Stanford type A aortic dissection

作　　者：李田江 王莽原 霍强[1] LI Tianjiang;WANG Mangyuan;HUO Qiang(Department of Cardiology,Heart Center,The First Affiliated Hospital of Xinjiang Medical University,Urumchi,830054,P.R.China)

机构地区：[1]新疆医科大学第一附属医院心脏中心心脏外科,乌鲁木齐830054

出　　处：《中国胸心血管外科临床杂志》2021年第12期1447-1454,共8页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

摘　　要：目的探究急性Stanford A型主动脉夹层并急诊行手术治疗患者在院期间早期死亡的危险因素。方法回顾性收集2017年1月至2020年1月期间就诊于新疆医科大学第一附属医院诊断为急性Stanford A型主动脉夹层并于入院24 h内急诊行手术治疗患者共189例,其中男160例、女29例,年龄(46.35±9.17)岁,记录患者入院24 h内相关检验结果,依据患者在我院住院期间转归情况(存活或死亡)分为存活组(n=160)和死亡组(n=29),手术方式根据主动脉夹层累及范围及其病变特点进行选择。分析急性Stanford A型主动脉夹层术后患者早期死亡的危险因素。结果 189例急性Stanford A型主动脉夹层患者中院内死亡29例,院内死亡率为15.34%。单因素分析结果提示,两组患者入院24 h内检验结果中,白细胞计数、血糖、门冬氨酸氨基转移酶(AST)、胆红素、肌酐、手术方式、手术时间、主动脉阻断时间、体外循环时间差异均有统计学意义(P<0.05)。多因素logistic回归分析结果提示,急性Stanford A型主动脉夹层患者入院24 h内白细胞计数[OR=1.142,95%CI(1.008,1.293)]、胆红素[OR=0.906,95%CI(0.833,0.985)]、肌酐[OR=1.009,95%CI(1.000,1.017)]、体外循环时间[OR=1.013,95%CI(1.003,1.024)]是急性Stanford A型主动脉夹层患者术后早期院内死亡的独立危险因素(P<0.05)。结论急性Stanford A型主动脉夹层患者入院24 h内白细胞计数、总胆红素水平、血肌酐水平、体外循环时间是急性Stanford A型主动脉夹层患者术后早期院内死亡的独立危险因素。Objective To investigate the risk factors for early in-hospital death in patients with acute Stanford type A aortic dissection and emergency surgical treatment. Methods We retrospectively analyzed the clinical data of 189 patients with acute Stanford type A aortic dissection who underwent surgery in the First Affiliated Hospital of Xinjiang Medical University between January 2017 and January 2020. There were 160 males and 29 females with an average age of 46.35±9.17 years. All patients underwent surgical treatment within 24 hours. The patients were divided into a survival group(n=160) and a death group(n=29) according to their outcome(survival or death) during hospitalization in our hospital. Perioperative clinical data were analyzed and compared between the two groups. Results The overall inhospital mortality was 15.34%(29/189). There was a statistical difference between the two groups in white blood cell count, blood glucose, aspartate aminotransferase(AST), bilirubin, creatinine, operative method, operation time, aortic occlusion time, or cardiopulmonary bypass time(P<0.05). Multivariate regression identified white blood cell count[OR=1.142, 95%CI(1.008, 1.293)], bilirubin [OR=0.906, 95%CI(0.833, 0.985)], creatinine [OR=1.009, 95%CI(1.000,1.017)], cardiopulmonary bypass time [OR=1.013, 95%CI(1.003, 1.024)] as postoperative risk factors for early in-hospital death in the patients undergoing acute Stanford type A aortic dissection surgery(P<0.05). Conclusion Our study demonstrated that white blood cell, bilirubin, creatinine and cardiopulmonary bypass time are independent risk factors for in-hospital death after acute Stanford type A aortic dissection surgery.

关 键 词：急性Stanford A型主动脉夹层 危险因素 白细胞计数 总胆红素 血肌酐 体外循环时间 手术 

分 类 号：R654.3[医药卫生—外科学]