A型主动脉夹层术后消化道出血危险因素的回顾性队列研究  

Risk factors for gastrointestinal bleeding after type A aortic dissection surgery:A retrospective cohort study

作　　者：程浩 李白翎 唐杨烽 韩林 徐志云 周炜 CHENG Hao;LI Bailing;TANG Yangfeng;HAN Lin;XU Zhiyun;ZHOU Wei(Department of Cardiovascular Surgery,The First Affiliated Hospital of Naval Medical University,Shanghai,200433,P.R.China;Department of Critical Care Medicine,Shanghai East Hospital,Tongji University of School Medicine,Shanghai,200120,P.R.China)

机构地区：[1]海军军医大学附属第一医院心血管外科,上海200433 [2]上海市东方医院重症医学科,上海200120

出　　处：《中国胸心血管外科临床杂志》2024年第4期531-537,共7页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

基　　金：国家自然科学基金(81870344)。

摘　　要：目的探讨A型主动脉夹层患者术后消化道出血(gastrointestinal bleeding,GIB)的危险因素,并讨论其预防和治疗方法。方法回顾性分析2017—2021年海军军医大学附属第一医院心血管外科收治的A型主动脉夹层术后患者的临床资料。根据术后是否存在GIB将患者分为GIB组和non-GIB组。将两组差异有统计学意义的单变量纳入多因素logistic回归模型,分析A型主动脉夹层患者术后GIB的危险因素。结果GIB组纳入患者18例[男12例、女6例,平均年龄(60.11±10.63)岁],non-GIB组纳入患者511例[男384例、女127例,平均年龄(49.81±12.88)岁]。单因素分析中,两组患者的年龄、术前经皮动脉血氧饱和度(percutaneous arterial oxygen saturation,SpO2)<95%、术中停循环时间、术后低心排血量综合征、撤除呼吸机时间>72 h、术后吸入气氧浓度(FiO2)≥50%、连续性肾脏替代治疗(continuous renal replacement therapy,CRRT)率、体外膜肺氧合(extracorporeal membrane oxygenation,ECMO)使用率、感染率、住院时间、住ICU时间、住院死亡率差异有统计学意义(P均<0.05)。多因素logistic回归分析中,两组患者术前SpO2<95%[OR=10.845,95%CI(2.038,57.703)]、撤除呼吸机时间>72 h[OR=0.004,95%CI(0.001,0.016)]、CRRT[OR=6.822,95%CI(1.778,26.171)]是患者术后GIB的危险因素(P均≤0.005)。GIB组内分析中,非闭塞性肠系膜缺血(non-occlusive mesenteric ischemia,NOMI)占38.9%(7/18),是A型主动脉夹层患者术后GIB的主要疾病类型。结论除夹层累及肠系膜上动脉的患者术后消化道易出血外,术前SpO2<95%、撤除呼吸机时间>72 h、CRRT是A型主动脉夹层患者术后GIB的独立危险因素。NOMI是GIB的主要疾病种类,及时诊断、积极治疗是降低死亡率的有效途径。对其危险因素的认知及治疗,也是降低其发病率的方法。Objective To investigate the risk factors for postoperative gastrointestinal bleeding(GIB)in patients with type A aortic dissection,and further discuss its prevention and treatment.Methods The clinical data of patients with type A aortic dissection admitted to the Department of Cardiovascular Surgery of the First Affiliated Hospital of Naval Medical University from 2017 to 2021 were retrospectively analyzed.Patients were divided into a GIB group and a non-GIB group based on the presence of GIB after surgery.The variables with statistical differences between two groups in univariate analysis were included into a multivariate logistic regression model to analyze the risk factors for postoperative GIB in patients with type A aortic dissection.Results There were 18 patients in the GIB group including 12 males and 6 females,aged 60.11±10.63 years,while 511 patients in the non-GIB group including 384 males and 127 females,aged 49.81±12.88 years.In the univariate analysis,there were statistical differences in age,preoperative percutaneous arterial oxygen saturation(SpO2)<95%,intraoperative circulatory arrest time,postoperative low cardiac output syndrome,ventilator withdrawal time>72 hours,postoperative FiO2≥50%,continuous renal replacement therapy(CRRT)rate,extracorporeal membrane oxygenation(ECMO)rate,infection rate,length of hospital stay and ICU stay,and in-hospital mortality(all P<0.05).In the multivariate logistic regression analysis,preoperative SpO2<95%(OR=10.845,95%CI 2.038-57.703),ventilator withdrawal time>72 hours(OR=0.004,95%CI 0.001-0.016),CRRT(OR=6.822,95%CI 1.778-26.171)were risk factors for postoperative GIB in patients(P≤0.005).In the intra-group analysis of GIB,non-occlusive mesenteric ischemia(NOMI)accounted for 38.9%(7/18)and was the main disease type for postoperative GIB in patients with type A aortic dissection.Conclusion In addition to patients with entrapment involving the superior mesenteric artery who are prone to postoperative GIB,preoperative SpO2<95%,ventilator withdrawal time>72 hou

关 键 词：A型主动脉夹层 消化道出血 非闭塞性肠系膜缺血 

分 类 号：R654.3[医药卫生—外科学]