急性主动脉夹层合并新型冠状病毒感染患者行急诊心脏外科手术的临床预后分析  

Clinical outcome of emergency cardiac surgery in acute aortic dissection patients combined with COVID-19

作　　者：杨晓芳[1] 赵雪婷[1] 付琳 关明[1] 侯晓彤[2] 黑飞龙 Yang Xiaofang;Zhao Xueting;Fu Lin;Guan Ming;Hou Xiaotong;Hei Feilong(Department of Extracorporeal Circulation and Mechanical Circulation Assistants,Center for Cardiac Intensive Care,Beijing Anzhen Hospital,Capital Medical University,Beijing 100029,China)

机构地区：[1]首都医科大学附属北京安贞医院体外循环与机械循环辅助科,北京100029 [2]首都医科大学附属北京安贞医院危重症中心,北京100029

出　　处：《中国体外循环杂志》2024年第3期204-209,共6页Chinese Journal of Extracorporeal Circulation

基　　金：国家自然科学基金(U23A20486)。

摘　　要：目的探讨新型冠状病毒(新冠)感染对急性主动脉夹层患者急诊心脏外科手术围术期的相关影响。方法连续收集北京安贞医院2022年12月11日至2023年1月30日急诊体外循环下行主动脉夹层手术患者,根据围术期是否感染新冠病毒,分为感染组和非感染组,比较两组患者围术期临床资料和术后结局。结果共纳入55例患者,其中感染组17例(31%),非感染组38例(69%)。感染组较非感染组患者术前合并冠心病[5例(29.4%)vs.2例(5.3%),P=0.017]、术后气管切开[2例(11.8%)vs.0(0%),P=0.033]比例更高,差异有统计学意义。感染组术后肺部感染、持续性肾替代治疗(CRRT)、脑卒中比例更高,住院时长、ICU时间和机械通气时间更长,但差异均无统计学意义。结论急性主动脉夹层合并新冠感染患者行体外循环下急诊心脏外科手术预后良好,但感染组术后肺部感染、CRRT、脑卒中等并发症发生率较非感染组有增高的趋势,因此应加强此类患者围术期管理,积极防治肺、肾、脑等并发症,预防继发性感染及急性栓塞事件,改善患者预后。Objective To investigate the impact of COVID-19 infection on the postoperative outcomes in patients with acute aortic dissection(AAD)undergoing emergency cardiac surgery.Methods Patients with AAD undergoing emergency cardiac surgery under cardiopulmonary bypass(CPB)at Beijing Anzhen Hospital from December 11,2022 to January 30,2023,were continuously collected.They were divided into infection group and non-infection group according to whether infected with COVID-19 during the perioperative period.The clinical data and postoperative outcomes of the two groups of patients were compared.Results A total of 55 patients were included,of which 17(31%)were infected with COVID-19 during the perioperative period,and 38(69%)were non-infected.The proportion of patients with preoperative coronary heart disease[5(29.4%)vs 2(5.3%),P=0.017]and the proportion of postoperative tracheostomy[2(11.8%)vs 0(0%),P=0.033]were significantly higher in the infection group,with statistical significance.The infection group had higher proportions of postoperative pulmonary infection,CRRT and stroke,longer hospital stays,ICU stays and mechanical ventilation times,but the differences were not statistically significant.Conclusion The prognosis of patients with AAD combined with COVID-19 undergoing emergency cardiac surgery under CPB is good.However,patients in the infection group have an increased tendency for complications such as postoperative pulmonary infection,CRRT and stroke compared to the non-infection group.Therefore,such patients should strengthen perioperative management,actively prevent and treat complications such as pulmonary,renal,and cerebral complications,prevent secondary infections and acute embolic events,thereby improving patient prognosis.

关 键 词：新型冠状病毒感染 急性主动脉夹层 心脏外科手术 体外循环 预后 

分 类 号：R654.2[医药卫生—外科学]