腹主动脉覆膜支架腔内修复术后并发症相关的术中危险因素与预警模型研究  

Study on intraoperative risk factors and early warning models related to post-operative complications after abdominal aorta covered stent endovascular aortic repair

作　　者：尹萌萌 王子路 Yin Mengmeng;Wang Zilu(Anesthesia and Surgery Center,Beijing Friendship Hospital,Capital Medical University,Beijing 100050,China;Department of Vascular Surgery,Lianyungang Second People's Hospital,Lianyungang 222000,Jiangsu,China)

机构地区：[1]首都医科大学附属北京友谊医院麻醉手术中心,北京100050 [2]连云港市第二人民医院血管外科,江苏连云港222000

出　　处：《血管与腔内血管外科杂志》2023年第10期1194-1198,共5页Journal of Vascular and Endovascular Surgery

摘　　要：目的探讨腹主动脉覆膜支架腔内修复术(EVAR)后并发症相关的术中危险因素与预警模型。方法收集2020年1月至2022年12月于首都医科大学附属北京友谊医院进行覆膜支架EVAR治疗的90例腹主动脉瘤患者的临床资料,将30例发生术后并发症的患者作为并发症组,根据并发症组患者的年龄、性别按1:2的比例采用倾向性评分匹配法将60例未发生术后并发症的患者作为无并发症组。采用多因素Logistic回归模型分析腹主动脉覆膜支架EVAR术后并发症相关的术中危险因素,明确危险因素与腹主动脉瘤覆膜支架EVAR术后发生并发症的关系并建立预警模型,根据预警模型制定术中预防措施。结果单因素分析结果显示,并发症组患者术中栓塞双侧髂内动脉的比例、术中最低体温、术中平均动脉压(MAP)最大差均高于无并发症组患者,差异均有统计学意义(P﹤0.05)。多因素分析结果显示,术中最低体温较高为腹主动脉覆膜支架EVAR术后发生并发症的保护因素(P﹤0.05),术中MAP最大差较大、术中栓塞双侧髂内动脉均为腹主动脉覆膜支架EVAR术后发生并发症的危险因素(P﹤0.05)。根据危险因素建立腹主动脉覆膜支架EVAR术后发生并发症的预警模型,术中MAP最大差的cut-off值≥16.16 mmHg(1 mmHg=0.133 kPa),术中最低体温的cut-off值≤36.30℃;术中MAP最大差的曲线下面积(AUC)为0.778,术中最低体温的AUC为0.713。结论腹主动脉覆膜支架EVAR术中给予保温措施、预防血压过度波动、尽量保留单侧髂内动脉可有效降低患者术后并发症的发生风险。Objective To investigate the intraoperative risk factors and early warning models related to postoperative complications after abdominal aorta covered stent endovascular aortic repair(EVAR).Method The clinical data of 90 cases patients with abdominal aortic aneurysms who underwent EVAR treatment with covered stent at Beijing Friendship Hospital,Capital Medical University from January 2020 to December 2022 were collected.Thirty patients with postoperative complications were included in the complication group.According to the age and gender of the patients in the complication group,the propensity score matching method was used to select 60 patients without postoperative complications at a ratio of 1:2 as the no-complication group.A multivariate Logistic regression model was used to analyze the intraoperative risk factors related to complications after abdominal aorta covered stent EVAR.The relationship between these risk factors and complications after abdominal aorta covered stent EVAR was clarified and an early warning model was established.Intraoperative preventive measures were developed based on this model.Result The results of univariate analysis showed that the proportion of bilateral internal iliac arteries embolized during surgery,the lowest intraoperative body temperature,and the intraoperative mean arterial pressure(MAP)maximum difference in the complication group were all higher than those in the no-complication group,and the differences were statistically significant(P<0.05).Multivariate analysis results showed that a higher intraoperative minimum body temperature was a protective factor for complications after abdominal aorta covered stent EVAR(P<0.05);larger intraoperative MAP maximum difference and intraoperative embolization of both internal iliac arteries were risk factors for complications after abdominal aorta covered stent EVAR(P<0.05).An early warning model for complications after abdominal aorta covered stent EVAR was established based on risk factors.The cut-off value for the intraoperative

关 键 词：腹主动脉瘤 覆膜支架腔内修复术 并发症 危险因素 预警模型 

分 类 号：R543[医药卫生—心血管疾病]