急性A型主动脉夹层体外循环术中氧输送与术后病死率相关性研究  

Correlation between intraoperative oxygen delivery and postoperative mortality in patients with acute type A aortic dissection undergoing cardiopulmonary bypass

作　　者：林天晓 陈星 孟维朋 官莉[1] 郑少忆[1] 彭勤宝 LIN Tian-xiao;CHEN Xing;MENG Wei-peng;GUAN Li;ZHENG Shao-yi;PENG Qin-bao(Department of Cardiovascular surgery,Nanfang Hospital,Southern Medical University,Guangzhou 510515,China)

机构地区：[1]南方医科大学南方医院心血管外科,广州市510515

出　　处：《中国心血管病研究》2023年第11期976-981,共6页Chinese Journal of Cardiovascular Research

基　　金：广东省医学科学技术研究基金(B2021025)。

摘　　要：目的探讨在急性StanfordA型主动脉夹层(ATAAD)体外循环(CPB)术中使用目标导向灌注策略保持氧输送(DO2)≥280 ml·min^(-1)·m^(-2)与患者90 d病死率的关系。方法回顾性分析2018年1月至2022年7月南方医科大学南方医院心血管外科收治的178例行孙氏手术的A型主动脉夹层患者的临床资料,其中男性158例(88.8%),平均年龄(50.9±12.6)岁,根据CPB中平均DO2是否低于(280 ml·min^(-1)·m^(-2))分为低氧供组(n=23)和常规组(n=155),比较两组临床资料并进行随访,主要研究终点为术后90天全因死亡率,次要研究终点为术后机械通气时间、连续肾替代治疗(CRRT)使用、脑部并发症等术后并发症发生率的比较。结果全组患者共23例(12.9%)发生术后90 d内死亡,与低氧供组相比,常规组在CPB中血流量[(2.7±0.2)L·min^(-1)·m^(-2)比(2.3±0.2)L·min^(-1)·m^(-2)]、红细胞压积(25.5%比23.8%)、DO2[(328.1±28.4)ml·min^(-1)·m^(-2)比(257.5±18.4)ml·min^(-1)·m^(-2)]、氧供氧耗比值(3.9比3.5)等更高(均P<0.05),术后CRRT使用率(7.7%比30.4%)、术后90 d内病死率(10.3%比30.4%)更低(均P<0.05),其余指标无统计学差异。术后中位随访时间为4(1~38)个月,生存分析结果表明,两组患者的生存时间存在显著差异(Z=9.201,Log rank P=0.002),单因素Cox回归发现,常规组可将90 d内病死风险降低72.1%(HR=0.279,95%CI 0.114~0.68,P=0.005)。结论急性A型主动脉夹层体外循环中通过提升流量、红细胞比容等措施维持氧输送DO2≥280 ml·min^(-1)·m^(-2)与术后90 d病死率降低相关。Objective To investigate the relationship between goal-directed perfusion strategy to maintain DO2>280 ml·min^(-1)·m^(-2) and 90-day mortality in patients with acute type A aortic dissection during cardiopulmonary bypass.Methods The clinical data of 178 patients with acute type A aortic dissection who underwent Sun’s surgery in The Department of Cardiovascular Surgery,Nanfang Hospital,Southern Medical University from January 2018 to July 2022 were retrospectively analyzed.The patients were divided into the hypoxic group(n=23)and conventional group(n=155).The clinical data of the two groups were compared and followed up.The primary end point was 90-day all-cause mortality,and the secondary end point was the postoperative mechanical ventilation time,continuous renal replacement therapy(CRRT)use,brain complications and other postoperative complications.Results 23 patients(12.9%)died in hospital.Compared with the hypoxic group,in the conventional group,blood flow[(2.7±0.2)L/min·m2 vs.(2.3±0.2)L·min^(-1)·m^(-2)],hematocrit(25.5%vs.23.8%),DO2[(328.1±28.4)ml·min^(-1)·m^(-2) vs.(257.5±18.4)ml·min^(-1)·m^(-2)]and oxygen delivery/oxygen consumption ratio(3.9 vs.3.5)(all P<0.05)were higher;the need for CRRT(7.7%vs.30.4%)and the in-hospital mortality(10.3%vs.30.4%)were lower(P<0.05).There was no significant difference in other indicators.The median follow-up time was 4(1,38)months.Kaplan-Meier curve results showed that there was a significant difference in the survival time between the 2 groups(Z=9.201,Log rank P=0.002).Conclusion Maintaining oxygen delivery(DO2)>280 ml·min^(-1)·m^(-2) during cardiopulmonary bypass by increasing CPB flow and hematocrit is beneficial to reduce the CRRT use and the 90-day mortality of acute type A aortic dissection.

关 键 词：急性A型主动脉夹层 氧输送 病死率 连续肾替代治疗 生存分析 

分 类 号：R543.1[医药卫生—心血管疾病]