急性Stanford A型主动脉夹层外科术后卒中危险因素分析  

Risk factors for postoperative stroke in patients with acute stanford type A aortic dissection

作　　者：龙杰 向宇鑫 方超林 张文[2] 肖红艳 LONG Jie;XIANG Yu-xin;FANG Chao-lin;ZHANG Wen;XIAO Hong-yan(Medical School,Wuhan University of Science and Technology,Wuhan 430022,China;Department of Cardiac Surgery,Wuhan Asian Heart Hospital Affiliated to Wuhan University of Science and Technology,Wuhan 430022,China)

机构地区：[1]武汉科技大学医学院,湖北省武汉市430022 [2]武汉科技大学附属武汉亚洲心脏病医院心脏外科

出　　处：《中国心血管病研究》2023年第2期177-181,共5页Chinese Journal of Cardiovascular Research

基　　金：湖北省卫生健康委科研项目(WJ2019F024)。

摘　　要：目的分析急性Stanford A型主动脉夹层(ATAAD)患者外科术后新发卒中的危险因素。方法收集2019年6月至2020年12月期间于武汉亚洲心脏病医院连续收治并行急诊手术的145例ATAAD手术患者围手术期的临床资料,根据术后是否发生卒中分为卒中组与非卒中组,纳入围手术期的一般资料与各项指标进行统计学分析,分析术后新发卒中的危险因素。结果卒中组与非卒中组在年龄、性别、BMI、夹层是否累及冠状动脉、夹层是否累及左颈总动脉与无名动脉,术前D二聚体、术前白细胞水平、手术方式、手术时间、术中体外循环时间、术中阻断时间、术后血肌酐值、术后D二聚体等指标之间的差异无统计学意义(P>0.05);卒中组在术前血肌钙蛋白CTnⅠ水平、伴有心脏手术史、卒中史、术中采用股动脉插管的比例等方面均高于非卒中组,差异均有统计学意义(P<0.05)。在预后方面,卒中组术后发生肺部感染病、气管切开的比例更高,且术后30 d的病死率明显高于非卒中组(38.9%比4.7%),其差异均有统计学意义(P<0.05)。Logistic多因素回归分析结果表明,术前卒中史(OR=0.127,95%CI 0.026~0.619)、术前心脏手术史(OR=0.083,95%CI0.012~0.602),术中采用股动脉插管(OR=0.073,95%CI 0.008~0.691)是ATAAD患者外科手术后发生卒中的独立危险因素(P<0.05)。结论本研究中ATAAD患者急诊术后发生卒中的独立危险因素为卒中史、心脏手术史、股动脉插管,且术后发生卒中会对预后造成严重不良影响。因此,应加强对高危人群的筛查,做好预防管理工作,以降低术后卒中发生率,改善患者预后。Objective To analyze the risk factors for new strokes following the surgery in acute Stanford type A aortic dissection(ATAAD).Methods The perioperative clinical data of 145 patients with acute Stanford type A aortic dissection who were consecutively treated in Wuhan Asia Heart Hospital and underwent emergency surgery from June 2019 to December 2020 were collected and divided into the stroke group and the non-stroke group;the general data and various indicators during the perioperative period were recorded for the statistical analysis including the risk factors of postoperative new stroke.Results There was no statistically significant difference between the two groups in the age,gender,BMI,whether the dissection involved coronary artery,whether the dissection involved the left common carotid artery and innominate artery,preoperative D-dimer,preoperative leukocyte level,operation method,operation time,intraoperative cardiopulmonary bypass time,intraoperative cut-off time,postoperative serum creatinine value and postoperative D-dimer(P>0.05).The history of stroke and the proportion of intraoperative femoral artery cannulation in the stroke group were higher than those in the non-stroke group,and the differences were statistically significant(P<0.05).In terms of prognosis,the stroke group had a higher proportion of postoperative pulmonary infection and tracheostomy;the 30-day postoperative mortality rate was significantly higher(38.9%vs.4.7%);and the differences were statistically significant(P<0.05).Logistic multivariate regression analysis showed that history of preoperative stroke(OR=0.127,95%CI 0.026-0.619),history of preoperative cardiac surgery(OR=0.083,95%CI 0.012-0.602),intraoperative use of femoral arterial cannulation(OR=0.073,95%CI 0.008-0.691)were the independent risk factors for stroke in patients with ATAAD after the surgery(P<0.05).Conclusion The history of stroke,cardiac surgery and femoral arterial cannulation are the independent risk factors of stroke in patients with ATAAD after the emergency surge

关 键 词：主动脉夹层 卒中 危险因素 术后 

分 类 号：R543.1[医药卫生—心血管疾病]