体外循环时间在术中超滤量与Stanford A型主动脉夹层患者术后90 d死亡率间的中介效应  

Mediation effect on cardiopulmonary bypass time between intraoperative ultrafiltration volume and 90 d postoperative mortality in patients with Stanford type A aortic dissection

作　　者：何小霞[1] 彭勤宝 陈星 孟维朋 林天晓 HE Xiaoxia;PENG Qinbao;CHEN Xing;MENG Weipeng;LIN Tianxiao(Department of Cardiovascular Surgery,Nanfang Hospital,Southern Medical University,Guangdong Province,Guangzhou510515,China)

机构地区：[1]南方医科大学南方医院心血管外科,广东广州510515

出　　处：《中国医药导报》2024年第19期112-117,共6页China Medical Herald

基　　金：广东省医学科学技术研究基金项目(B2024020)。

摘　　要：目的探索体外循环(CPB)时间(TCPB)在术中超滤量(UFV)与Stanford A型主动脉夹层(TAAD)患者发生术后90 d死亡的中介效应。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176例行手术治疗的TAAD患者的临床资料,根据术后90 d生存情况分为生存组(157例)和死亡组(19例)。比较两组基线及围手术期临床指标,中介分析使用Mplus 8.0软件分析TCPB在UFV与结局事件(发生术后90 d死亡)之间的中介效应,由于结局事件变量为二分类变量,中介分析效应量采用stdyx完全标准化进行等尺度化,并用重复自采样10000次的非参数百分位偏差校正的bootstrap法进行检验。结果本研究全组患者90 d内死亡率为10.79%。两组TCPB、主动脉阻断时间、CPB中液体总入量及总出量、超滤总量、UFV、术后呼吸机时间、清醒时间、脑部并发症发生率、连续肾替代治疗(CRRT)使用率及体外膜肺氧合应用率、伤口愈合不良事件发生率及术后住院日指标比较,差异均有统计学意义(P<0.05)。中介分析结果显示,经标准化后TCPB在UFV和结局事件间起部分中介(总效应、直接效应、中介效应均显著)作用,总效应为0.334(95%CI:0.098~0.544,P=0.003),直接效应为0.225(95%CI:0.005~0.444,P=0.043)。中介效应为0.109(95%CI:0.024~0.216,P=0.024)。结论TCPB在UFV与TAAD患者发生术后90 d内死亡之间发挥部分中介作用,为改善TAAD患者预后应优先缩短TCPB而非减少UFV。在二分因变量的小样本简单中介模型中的参数估计使用稳健的加权最小二乘估计方法加权最小二乘法结合stdyx法会影响中介效应结果。Objective To explore the mediation effect on cardiopulmonary bypass(CPB)time(TCPB)between intraoperative ultrafiltration volume(UFV)and 90 d postoperative mortality in patients with Stanford type A aortic dissection(TAAD).Methods Retrospective analysis of clinical data of 176 patients with TAAD admitted to the Department of Cardiovascular Surgery,Nanfang Hospital,Southern Medical University from January 2018 to July 2022 who underwent surgery,and they were divided into the survival group(157 patients)and the death group(19 patients)based on 90 d postoperative survival.Baseline and perioperative clinical indicators were compared between the two groups.Mediation analyses were performed to analyse the mediation effect on TCPB between UFV and the outcome event(occurrence of death at 90 d postoperatively)using Mplus 8.0 software.As the ending event variables were dichotomous,the mediation analysis effect sizes were isoscaled using stdyx complete standardisation and tested using the bootstrap method corrected for non-parametric percentile bias with repeated self-sampling 10000 times.Results The mortality rate within 90 d in the whole group of patients in this study was 10.79%.Comparison of TCPB,aortic block time,total fluid intake and total output in CPB,total ultrafiltration volume,UFV,postoperative ventilator time,awake time,incidence of cerebral complications,use of continuous renal replacement therapy(CRRT)and application of extracorporeal membrane pulmonary oxygenation,incidence of adverse events of wound healing,and postoperative hospital day metrics between the two groups,the differences were statistically significant(P<0.05).The results of mediation analysis showed that TCPB played a partial mediating role(total effect,direct effect,and intermediate effect were all significant)between UFV and outcome events after standardization.The total effect was 0.334(95%CI:0.098-0.544,P=0.003),and the direct effect size was 0.225(95%CI:0.005-0.444,P=0.043),and the mediation effect was 0.109(95%CI:0.024-0.216,P=0.024).Concl

关 键 词：超滤量 体外循环时间 死亡率 中介效应 Stanford A型主动脉夹层 类别变量 二分因变量 因果推断 

分 类 号：R543.1[医药卫生—心血管疾病]