急性Standford A型主动脉夹层术前低氧血症对术后消化道出血的影响分析  

Analysis on effect of preoperative hypoxemia on postoperative gastrointestinal bleeding in patients with acute type A aortic dissection

作　　者：李嘉骏 张宇聪 王靖[1] 周永智 胡敏[1] Li Jiajun;Zhang Yucong;Wang Jing;Zhou Yongzhi;Hu Min(Division of Cardiothoracic and Vascular Surgery,Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430030,Hubei,China;Institute of Gerontology,Department of Geriatrics,Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430030,Hubei,China)

机构地区：[1]华中科技大学同济医学院附属同济医院心脏大血管外科,湖北武汉430030 [2]华中科技大学同济医学院附属同济医院综合医疗科,湖北武汉430030

出　　处：《中国医学前沿杂志（电子版）》2024年第7期80-86,共7页Chinese Journal of the Frontiers of Medical Science(Electronic Version)

基　　金：湖北省自然科学基金计划项目(2023AFB672)。

摘　　要：目的探讨急性A型主动脉夹层(acute type A aortic dissection,ATAAD)患者术前低氧血症与术后消化道出血(gastrointestinal bleeding,GIB)的相关性,为ATAAD术后GIB的预测及诊治提供一定的参考。方法通过回顾性队列研究分析123例ATAAD患者围手术期临床资料。通过Logistic回归分析,探讨术前低氧血症与术后出现GIB之间的相关性。基于围手术期指标建立了预测ATAAD患者术后出现GIB的预测模型,通过计算受试者操作特征曲线(receiver op-erator characteristic curve,ROC曲线)曲线下面积(area under the curve,AUC)来评估模型的预测能力。结果纳入的ATAAD患者中,术前低氧血症发生率为26.0%(32/123),术后GIB发生率为8.1%(10/123)。单因素Logistic回归分析结果显示,ATAAD术前低氧血症(P=0.004)、C反应蛋白水平(P=0.021)、白细胞介素-6水平(P=0.020)及术中深低温停循环时间(P=0.001)与术后发生GIB的显著相关。多因素Logistic回归分析结果显示,术前低氧血症(P=0.024)和术中深低温停循环时间(P=0.010)是ATAAD患者术后出现GIB的独立危险因素。基于术前是否合并低氧血症、夹层是否累及肠系膜动脉及术中深低温停循环时间建立的临床预测模型可以很好地预测术后GIB的发生风险(AUC=0.913)。结论本研究发现ATAAD患者术前合并低氧血症与术中深低温停循环时间是术后GIB的独立危险因素。Objective To investigate the association between preoperative hypoxemia and postoperative gastrointestinal bleeding(GIB)in patients with acute type A aortic dissection(ATAAD),and provide reference for the prediction,diagnosis and treatment of postoperative GIB for ATAAD patients.Methods A retrospective cohort study was conducted to analyze the perioperative clinical data of 123 patients with ATAAD.The mean with standard deviation was used to describe the continuous variable,and the t test was used for the comparison between groups.Logistic regression analysis was performed to investigate the association between preoperative hypoxemia and postoperative GIB.In addition,a prediction model for postoperative GIB for ATAAD patients was established based on perioperative indicators,and the predictive efficiency of the model was evaluated by calculating the area under the receiver operating characteristic curve(AUC).Results Among all included patients,the incidence of preoperative hypoxemia was 26.0%(32/123),and the incidence of postoperative GIB was 8.1%(10/123).Univariate Logistic regression analysis showed that preoperative hypoxemia(P=0.004),C-reactive protein(P=0.021),interleukin-6(P=0.020)and intraoperative circulatory arrest time(P=0.001)were significantly associated with postoperative GIB.Multivariate Logistic regression analysis showed that preoperative hypoxemia(P=0.024)and intraoperative deep hypothermia circulatory arrest time(P=0.01)were independent risk factors for postoperative GIB in patients with ATAAD.The clinical prediction model based on preoperative hypoxemia,aortic dissection involving mesenteric artery and intraoperative deep hypothermia circulatory arrest time could well predict the risk of postoperative GIB(AUC=0.913).Conclusions Preoperative hypoxemia and intraoperative deep hypothermia circulatory arrest time are independent risk factors for postoperative GIB in ATAAD patients.

关 键 词：急性A型主动脉夹层 消化道出血 低氧血症 危险因素 临床预测模型 

分 类 号：R654.3[医药卫生—外科学]