Stanford A型主动脉夹层术后合并低氧血症的临床特征、预后及影响因素分析  

Clinical characteristics,prognosis and influencing factors of patients with Stanford type A aortic dissection complicated with postoperative hypoxemia

作　　者：纪沛君 张诚[1] 陈丹[1] 黄卫 吴庆琛[1] Ji Pei-Jun;Zhang Cheng;Chen Dan;Huang Wei;Wu Qing-Chen(Department of Thoracic Surgery/Cardiovascular and Large Vascular Surgery,the First Affiliated Hospital of Chongqing Medical University,Chongqing 400016,China)

机构地区：[1]重庆医科大学附属第一医院胸外科/心脏大血管外科,重庆400016

出　　处：《解放军医学杂志》2022年第4期353-358,共6页Medical Journal of Chinese People's Liberation Army

基　　金：重庆市基础科学与前沿技术研究项目(cstc2017jcyjAX0109)。

摘　　要：目的探讨Stanford A型主动脉夹层(TAAD)术后合并低氧血症患者的临床特征及其短期和长期预后的影响因素。方法连续纳入重庆医科大学附属第一医院2017年1月-2021年3月经胸部CT和(或)主动脉CT血管造影确诊的TAAD手术患者73例,按照术后是否合并低氧血症分为合并低氧血症组(n=36)与未合并低氧血症组(n=37),分析合并低氧血症组患者的临床特征,分别采用logistic回归模型和Cox比例风险模型分析低氧血症对TAAD患者术后短期、长期全死因死亡的影响。结果合并低氧血症组患者的年龄、BMI明显高于未合并低氧血症组,且术前谷丙转氨酶(ALT)、谷草转氨酶(AST)、白蛋白(ALB)、血清肌酐(Scr)、尿微量白蛋白(mALB)、TNF-α、IL-6、高敏C反应蛋白(hs-CRP)水平也明显高于未合并低氧血症组,差异均有统计学意义(P<0.05)。合并低氧血症组患者术后短期病死率明显高于未合并低氧血症组[22.2%(8/36)vs.5.4%(2/37),χ^(2)=4.365,P=0.037],而合并与未合并低氧血症组患者出院后长期病死率差异无统计学意义[13.9%(5/36)vs.8.1%(3/37),χ^(2)=0.625,P=0.429]。多因素logistic回归分析结果显示,合并低氧血症、年龄和TNF-α水平是TAAD患者术后短期死亡的独立危险因素(P<0.05)。多因素Cox回归分析结果显示,年龄、hs-CRP水平是TAAD患者出院后随访期间发生死亡的独立危险因素(P<0.05),而合并低氧血症不是TAAD患者出院后随访期间发生死亡的独立危险因素(P>0.05)。结论术后合并低氧血症的TAAD患者具有年龄大、BMI高、肝肾功能指标和炎性因子水平高等临床特点,且其术后短期死亡风险增加。Objective To investigate the clinical characteristics,short-term and long-term prognosis and influencing factors of patients with Stanford type A aortic dissection(TAAD)complicated with postoperative hypoxemia.Methods Seventy-three patients with TAAD confirmed by chest CT and(or)aortic CT angiography in the First Affiliated Hospital of Chongqing Medical University from January 2017 to March 2021 were enrolled.According to whether the postoperative hypoxemia was complicated with,patients were divided into two groups:with hypoxemia group(n=36)and without hypoxemia group(n=37).The clinical characteristics of TAAD patients with hypoxemia were analyzed.Logistic regression model and Cox proportional risk model were used to analyze the effect of hypoxemia on the short-term and long-term all cause death of TAAD patients.Results The average age and BMI level were significantly higher in TAAD patients with hypoxemia group than those in without hypoxemia group,and the preoperative levels of alanine aminotransferase(ALT),aspartate aminotransferase(AST),albumin(ALB),serum creatinine(Scr),urinary microalbumin(mALB)and TNF-α,IL-6 and high-sensitivity C-reactive protein(hs-CRP)were also significantly higher in with hypoxemia group than those in without hypoxemia group(P<0.05).The short-term mortality was significantly higher in with hypoxemia group than that in without hypoxemia group[22.2%(8/36)vs.5.4%(2/37);χ^(2)=4.365,P=0.037],but no significant difference between the two groups of patients in the long-term mortality after discharge[13.9%(5/36)vs.8.1%(3/7);χ^(2)=0.625,P=0.429].Multivariate logistic regression analysis showed that complication with hypoxemia,age and TNF-αlevel were the independent risk factors for postoperative short-term hospitalization death in TAAD patients(P<0.05).Multivariate Cox regression analysis showed that age and hs-CRP level were the independent risk factors for death of TAAD patients during follow-up after discharge(P<0.05).While complication with hypoxemia was not an independent risk factor f

关 键 词：Stanford A型主动脉夹层 低氧血症 临床特征 预后 

分 类 号：R543.1[医药卫生—心血管疾病] R645.3[医药卫生—内科学]