Standford A型主动脉夹层外科术后血小板降低与患者死亡率关联研究  

Association of thrombocytopenia with mortality after surgery in patients with Standford type A aortic dissection

作　　者：曹芳芳 张海涛[1] 吴进林 丘俊涛 赵锐 邱家伟 戴路 姜文翔 谢恩泽华 范舒雅 宋剑 高伟 于存涛[1] Cao Fangfang;Zhang Haitao;Wu Jinlin;Qiu Juntao;Zhao Rui;Qiu Jiawei;Dai Lu;Jiang Wenxiang;Xie Enzehua;Fan Shuya;Song Jian;Gao Wei;Yu Cuntao(Department of Surgical Intensive Care Unit,Fuwai Hospital,National Center for Cardiovascular Diseases,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100037,China;Department of Cardiac Surgery,Guangdong Provincial People′s Hospital,Guangzhou 510080,China;Department of Lymphatic Surgery,Century Temple Hospital,Beijing 100038,China)

机构地区：[1]阜外医院成人外科恢复室国家心血管病中心中国医学科学院/北京协和医学院,北京100037 [2]广东省人民医院心脏外科,广州510080 [3]北京世纪坛医院淋巴外科,北京100038

出　　处：《中华医学杂志》2022年第7期499-505,共7页National Medical Journal of China

基　　金：中国医学科学院医学与健康科技创新工程(2016-CXGC01-2)。

摘　　要：目的:评估Standford A型主动脉夹层体外循环术后血小板降低与患者死亡率的关联。方法:回顾性分析中国医学科学院阜外医院2017年5月至2018年12月498例Standford A型主动脉夹层外科手术患者的临床资料,其中男350例,女148例,年龄(51.7±12.0)岁。根据术后72 h内最低血小板计数将患者分为血小板降低组(血小板计数<75×1015/L,n=178)与血小板正常组(血小板计数≥75×1015/L,n=320),对其围手术期院内死亡率及相关并发症行logistic回归分析。主要终点为院内死亡率,次要终点包括二次开胸止血、肺部感染、术后持续肾脏替代治疗、截瘫、心力衰竭、住院时间及住重症监护病房(ICU)时间。结果:Standford A型主动脉夹层体外循环术后血小板降低发生率为35.7%(178/498)。单因素logistic回归分析显示,术后血小板计数降低与1项主要终点(院内死亡率)、7项次要终点明显相关(均P<0.05)。多因素回归分析显示,主动脉夹层术后血小板计数降低会提高术后死亡率(OR=12.57,95%CI:2.26~69.93,P=0.004)、二次开胸止血率(OR=6.21,95%CI:1.31~29.46,P=0.022)、持续肾脏替代治疗率(OR=7.51,95%CI:2.53~22.34,P<0.001)、截瘫(OR=23.99,95%CI:1.47~392.21,P=0.026)、心力衰竭发生率(OR=4.71,95%CI:1.19~18.62,P=0.027)及住ICU时间(OR=1.86,95%CI:1.11~3.12,P=0.019)。结论:Standford A型主动脉夹层体外循环术后血小板降低(72 h内出现过最低值)与术后院内死亡率有关联。Objective To evaluate the association of thromboytopenia with mortality of Standford type A aortic dissection after cardiopulmonary bypass surgery.Methods Total of 498 patients with Standford type A aortic dissection after surgery in Fuwai Hospital of the Chinese Academy of Medical Sciences from May 2017 to December 2018 were collected retrospectively.There were 350 males and 148 females,with a mean age of(51.7±12.0)years.The patients were divided into thrombocytopenia group(platelet count<75×1015/L,n=178)and normal platelet group(platelet count≥75×1015/L,n=320)according to the lowest platelet count within 72 hours after surgery.The perioperative in-hospital mortality and related complications were calculated by univariate and multivariate logistic regression analysis.The primary endpoint was in-hospital mortality,and the secondary endpoints included secondary thoracotomy,pneumonia,postoperative continuous renal replacement therapy,paraplegia,heart failure,length of hospital stay and intensive care unit(ICU)stay time.Results The morbidity of thrombocytopenia after Standford type A aortic dissection surgery was 35.7%(178/498).Univariate logistic regression analysis showed that postoperative thrombocytopenia was significantly associated with in-hospital mortality and 7 secondary endpoints(P<0.05).Multivariate logistic regression analysis showed thrombocytopenia after aortic dissection surgery was significantly associated with increased postoperative mortality(OR=12.57,95%CI:2.26-69.93,P=0.004),secondary thoracotomy(OR=6.21,95%CI:1.31-29.46,P=0.022),continuous renal replacement therapy(OR=7.51,95%CI:2.53-22.34,P<0.001),paraplegia(OR=23.99,95%CI:1.47-392.21,P=0.026),heart failure(OR=4.71,95%CI:1.19-18.62,P=0.027)and longer ICU stay time(OR=1.86,95%CI:1.11-3.12,P=0.019).Conclusions Thrombocytopenia after Standford type A aortic dissection after cardiopulmonary bypass surgery(the lowest platelet count within 72 hours)is strongly associated with postoperative in-hospital mortality.Trying to avoid the factors relate

关 键 词：动脉瘤 夹层 主动脉夹层 血小板降低 回顾性队列研究 

分 类 号：R654.2[医药卫生—外科学]