急性Stanford A型主动脉夹层患者术后死亡的危险因素及血清NT-proBNP、D-D联合监测对预后的评估价值  

Risk Factors of Postoperative Death in Patients with Acute Stanford Type A Aortic Dissection and the Prognostic Value of Serum NT-proBNP and D-D Combined Monitoring

作　　者：阿柯力江·凯赛尔 刘正[1] 伊力哈木江 朱涛[1] 霍强[1] Akelijiang·Kaisaier;LIU Zheng;Yilihamujiang;ZHU Tao;HUO Qiang(Department of Cardiac Surgery,The First Affiliated Hospital of Xinjiang Medical University,Urumqi,Xinjiang,830011,China)

机构地区：[1]新疆医科大学第一附属医院心脏外科,新疆乌鲁木齐830011

出　　处：《现代生物医学进展》2022年第12期2275-2279,2302,共6页Progress in Modern Biomedicine

基　　金：新疆维吾尔自治区自然科学基金项目(2016D01C336)。

摘　　要：目的:探讨急性Stanford A型主动脉夹层(ATAAD)患者术后死亡的危险因素,分析血清N-末端B型利钠肽原(NT-proBNP)、D-二聚体(D-D)联合监测在预后评估中的价值。方法:回顾性选择2017年10月至2020年10月我院收治的212例行手术治疗的ATAAD患者,追踪术后30 d生存情况,分为死亡组(36例)和存活组(176例)。收集并比较两组基线、手术和实验室相关资料,多因素Logistic回归分析ATAAD患者术后30 d内死亡的危险因素,受试者工作特征(ROC)曲线分析NT-proBNP、D-D单独及联合预测ATAAD患者术后30 d内死亡的价值。结果:死亡组年龄≥60岁、急性生理与慢性健康状况评估Ⅱ(APACHEⅡ)评分、序贯器官功能衰竭(SOFA)评分、血肌酐(Scr)、NT-proBNP、D-D,术前≥2个脏器灌注不良、联合冠脉旁路移植术(CABG)、术后输血、术后并发急性肾损伤、术后并发低心排、持续肾脏替代治疗(CRRT)人数占比,机械通气时间、重症监护病房(ICU)停留时间均高于存活组(P<0.05)。多因素Logistic回归分析显示术前≥2个脏器灌注不良、术后伴急性肾损伤、联合CABG、术后低心排、NT-proBNP、D-D是影响ATAAD患者术后30 d内死亡的危险因素(P<0.05)。NT-proBNP、D-D预测ATAAD患者术后30 d内死亡的曲线下面积为0.728、0.720,联合NT-proBNP和D-D的曲线下面积为0.834,高于单独应用NT-proBNP、D-D。结论:术前脏器灌注不良、术后急性肾损伤、联合CABG手术、术后低心排、NT-proBNP、D-D是影响ATAAD患者住院30d内死亡的危险因素,联合NT-proBNP和D-D在ATAAD患者预后评估有较高价值。Objective:To discussion the risk factors of postoperative death in patients with acute Stanford type A aortic dissection(ATAAD),and to analyze the value of serum N-terminal B-type natriuretic peptide(NT-proBNP)and D-dimer(D-D)combined monitoring in prognosis assessment.Methods:212 cases of patients with ATAAD undergoing surgical treatment who were admitted to our hospital from October 2017 to October 2020 were retrospectively selected.and the survival was tracked 30 days after operation,which were divided into death group(36 cases)and survival group(176 cases).Baseline,surgical and laboratory related data were collected and compared between the two groups,and multivariate Logistic regression was used to analyze the risk factors of death within30 days after operation in patients with ATAAD,and receiver operating characteristic(ROC)curve was used to analyze the value of NT-proBNP and D-D alone and combined in predicting death within 30 days after operation in patients with ATAAD.Results:The age≥60 years,acute physiological and chronic health evaluationⅡ(APACHEⅡ)score,sequential organ failure assessment(SOFA)score,blood creatinine(Scr),NT-proBNP,D-D,preoperative≥2 organs had poor perfusion,combined coronary artery bypass grafting(CABG),postoperative blood transfusion,postoperative acute kidney injury,postoperative low cardiac output,continuous renal replacement therapy(CRRT)patients proportion,mechanical ventilation time and intensive care unit(ICU)stay time in death group were higher than those in survival group(P<0.05).Multivariate Logistic regression analysis showed that preoperative≥2 organs had poor perfusion,postoperative acute kidney injury,combined CABG,postoperative low cardiac output,NT-proBNP and D-D were the risk factors affecting the death of patients with ATAAD within 30 days after operation(P<0.05).The area under the curve of NT-proBNP and D-D to predict the death of patients with ATAAD within 30 days after operation was 0.728 and 0.720,and the area under the curve of combined NT-proBNP and

关 键 词：Stanford A型 主动脉夹层 N-末端B型利钠肽原 D-二聚体 危险因素 

分 类 号：R543.1[医药卫生—心血管疾病]