急性A型主动脉夹层患者术后非计划再次气管插管的危险因素及其预测价值  

Risk factors and predictive values of unplanned reintubation after the surgery of acute type A aortic dissection

作　　者：胡佳文 闫炀[1] 师桃[1] HU Jiawen;YAN Yang;SHI Tao(Department of Cardiovascular Surgery,The First Affiliated Hospital of Xi’an Jiaotong University,Xi’an 710061,China)

机构地区：[1]西安交通大学第一附属医院心血管外科,陕西西安710061

出　　处：《西安交通大学学报（医学版）》2022年第4期534-538,共5页Journal of Xi’an Jiaotong University（Medical Sciences）

摘　　要：目的探讨急性A型主动脉夹层(ATAAD)患者术后非计划再次气管插管的危险因素及其预测价值。方法回顾性收集2021年1月至2021年6月在本院心血管外科接受手术治疗的69例ATAAD患者临床资料,手术方式根据主动脉根部病变特点和夹层累及范围进行选择。根据是否再次行气管插管将纳入患者分为顺利脱机组、再插管组和未脱机组,并纳入各组患者围手术期的各项指标,分析非计划再次插管的危险因素并评估其预测价值。结果再插管组及未脱机组手术时间、停循环时间均显著长于顺利脱机组(P分别为0.005,0.036)。与顺利脱机组相比,再插管组首次插管时间较长[27.8(13.2,71.1)h vs.88.4(34.3,114.9)h,P=0.013],无创呼吸机使用率较高(P<0.001)。在校正年龄、性别、体质指数(BMI)、高血压、糖尿病(DM)、慢性肾脏病(CKD)5期、吸烟史等混杂因素后,手术时间(OR=6.913;95%CI:1.099,43.484;P=0.039)及需无创呼吸机辅助(OR=92.790;95%CI:4.932,1745.797;P=0.002)是非计划性再次气管插管的独立危险因素。手术时间>7 h且脱机后需无创呼吸机辅助这一危险因素对再次插管具有很好的预测价值,受试者工作特征(ROC)曲线下面积为0.838(95%CI:0.729,0.916),敏感性、特异性分别为83.3%、84.2%。结论手术时间延长和脱机后需无创呼吸机辅助是再次插管的独立危险因素。Objective To analyze the risk factors of unplanned reintubation after the surgery of acute type A aortic dissection(ATAAD)and assess its predictive value.Methods The clinical data of 69 ATAAD patients,who underwent surgery in our department from January 2021 to June 2021,were retrospectively collected and analyzed.The operation procedure was performed based on the extent of dissection involved and the characteristics of aortic root lesions.The patients were divided into three groups based on whether weaning off ventilator and whether reintubation after weaning off.Perioperative and operative factors were compared among the three groups.Results The duration of surgery and circulatory arrest time were much longer in subjects of reintubation and those who did not wean off ventilator(P=0.005and 0.036,respectively).Compared to the group in which patients successfully weaned off ventilator,the first intubation time after surgery was longer[(27.8(13.2,71.1)h vs.88.4(34.3,114.9)h,P=0.013)]and the use rate of noninvasive ventilator(NIV)was higher in reintubation group(P<0.001).After adjusting for age,gender,BMI,hypertension,diabetes mellitus,chronic kidney diseases stage 5,and smoking,surgery time(OR=6.913,95%CI:1.099,43.484,P=0.039)and the use of NIV(OR=92.790,95%CI:4.932,1745.797,P=0.002)were independent risk factors for unplanned reintubation for ATAAD patients after surgery.Surgery duration>7 h and the use of NIV could well predict the occurrence of unplanned reintubation.The area under ROC curve was 0.838(95%CI:0.729,0.916),the sensitivity and specificity were 83.3%and 84.2%,respectively.Conclusion Surgery duration and the need of NIV support were risk factors for unplanned reintubation after ATAAD.

关 键 词：急性A型主动脉夹层 再次插管 危险因素 

分 类 号：R654.3[医药卫生—外科学]