急性Stanford A型主动脉夹层术后死亡的危险因素分析  

Analysis of risk factors for postoperative mortality in patients with acute Stanford type A aortic dissection

作　　者：潘兴纳 蒲磊[2] 梁荣鑫[1] 李伯海[1] 钟志敏[1] PAN Xing-na;PU Lei;LIANG Rong-xin(Department of Cardiovascular Surgery,Guangdong Second Provencial People's Hospital,Guangzhou 510317,China)

机构地区：[1]广东省第二人民医院心血管外科,510317 [2]昆明医科大学附属延安医院心脏大血管外科,650051

出　　处：《中国现代药物应用》2022年第22期1-4,共4页Chinese Journal of Modern Drug Application

摘　　要：目的分析急性Stanford A型主动脉夹层术后死亡的危险因素。方法120例急性Stanford A型主动脉夹层患者作为研究对象,根据患者术后是否死亡分为存活组(105例)和死亡组(15例)。回顾性分析患者的一般资料、相关检测指标、手术指标及术后并发症等内容。以患者是否生存为因变量,以患者一般资料、相关检测指标及术后并发症等作为自变量,分析急性Stanford A型主动脉夹层患者术后死亡的危险因素。结果死亡组年龄≥60岁占比86.67%、D-二聚体水平≥90 mg/L占比93.33%、体外循环时间≥270 min占比100.00%、术后并发症占比100.00%均高于存活组的22.86%、63.81%、40.95%、38.10%,差异具有统计学意义(P<0.05)。Logistic回归分析显示,年龄、D-二聚体水平、体外循环时间和术后并发症是急性Stanford A型主动脉夹层术后死亡的危险因素(OR=4.162、5.715、5.487、5.953,P<0.05)。受试者工作特征曲线(ROC曲线)分析显示:各危险因素联合预测效能均明显高于年龄、D-二聚体水平、体外循环时间及术后并发症[曲线下面积(AUC)=0.925、0.732、0.872、0.763、0.853,P<0.05];各危险因素联合预测的敏感度、特异度均明显高于年龄、D-二聚体水平、体外循环时间、术后并发症单一预测的敏感度与特异度,差异有统计学意义(P<0.05)。结论年龄、D-二聚体水平、体外循环时间、术后并发症是急性Stanford A型主动脉夹层术后死亡的危险因素,应强化对死亡危险因素的预防,并且预测死亡危险因素的效能,科学评估手术治疗效果和预后,进而为术后临床治疗和护理提供科学依据。Objective To analyze the risk factors for postoperative mortality in patients with acute Stanford type A aortic dissection.Methods A total of 120 patients with acute Stanford type A aortic dissection were selected as the research subjects,and were divided into a survival group(105 cases)and a mortality group(15 cases)according to whether the patients died or not.The patients'general data,relevant test indexes,surgical indexes and postoperative complications were retrospectively analyzed.The risk factors for postoperative mortality in patients with acute Stanford type A aortic coarctation were analyzed with whether the patients survived as the dependent variable and the patients'general data,relevant testing indexes and postoperative complications as the independent variables.Results In the mortality group,the age≥60 years accounted for 86.67%,D-dimer level≥90 mg/L accounted for 93.33%,extracorporeal circulation time≥270 min accounted for 100.00%,and postoperative complications accounted for 100.00%,which were higher than 22.86%,63.81%,40.95%,and 38.10%in the survival group,and the differences were all statistically significant(P<0.05).Logistic regression analysis showed that age,D-dimer level,duration of extracorporeal circulation,and postoperative complications were risk factors for postoperative mortality of acute Stanford type A aortic dissection(OR=4.162,5.715,5.487,5.953;P<0.05).Receiver operating characteristic(ROC)curve analysis showed that:①the combined prediction of each risk factor was significantly higher than that of age,D-dimer level,cardiopulmonary bypass time and postoperative complications[area under the curve(AUC)=0.925,0.732,0.872,0.763,0.853;P<0.05].②The sensitivity and specificity of the combined prediction of each risk factor were significantly higher than the sensitivity and specificity of the single prediction of age,D-dimer level,extracorporeal bypass time,and postoperative complications, and the difference was statistically significant (P<0.05). Conclusion Age, D-dimer level, ex

关 键 词：急性Stanford A型主动脉夹层 死亡 危险因素 预后 

分 类 号：R654.2[医药卫生—外科学]