Stanford A型主动脉夹层术后低氧血症风险因素分析  

Risk Factors of Postoperative Hypoxemia for Patients with Stanford Type A Aortic Dissection

作　　者：刘海渊[1] 高晴云[1] 张成鑫[1] 刘愚勇 葛圣林[1] LIU Haiyuan;GAO Qingyun;ZHANG Chengxin;LIU Yuyong;GE Shenglin(Department of Cardiovascular Surgery,The First Affiliated Hospital of Anhui Medical University,Hefei 230022,China)

机构地区：[1]安徽医科大学第一附属医院心脏大血管外科,合肥230022

出　　处：《岭南心血管病杂志》2024年第4期351-357,共7页South China Journal of Cardiovascular Diseases

摘　　要：目的了解Stanford A型主动脉夹层患者术后低氧血症的独立危险因素,并探讨术后低氧血症对患者预后的影响。方法对2018年12月至2023年6月安徽医科大学第一附属医院心脏大血管外科共计收治的109例Stanford A型主动脉夹层患者进行围术期资料采集,根据患者术后是否并发低氧血症,将其分为低氧血症组和非低氧血症组。首先,对患者术前及术中资料进行单因素分析,单因素分析后,将具有统计学意义的变量资料行Logistic回归分析,最终明确术后低氧血症的独立危险因素。结果术后非低氧血症组患者64例,低氧血症组患者45例,经单因素分析,两组患者性别(P=0.001)、急诊(P=0.015)、体质量(P=0.000)、术前尿素氮浓度(P=0.008)和深低温停循环时间(P=0.042)比较,差异具有统计学意义。5个变量因素经Logistic回归分析后得出体质量(P=0.001)、急诊(P=0.004)和深低温停循环时间(P=0.015)具有统计学意义,为术后低氧血症的独立危险因素。两组患者术后12 h内清醒(P=0.000)、术后二次气管插管(P=0.017)、术后气管切开(P=0.001)、术后透析(P=0.032)、术后严重脏器损伤(P=0.000)、术后7 d内出重症监护病房(P=0.000)、术后四肢活动障碍(P=0.016)和非医嘱离院(P=0.001)比较,差异均具有统计学意义。结论体质量、急诊和深低温停循环时间是Stanford A型主动脉夹层患者术后低氧血症的独立危险因素。围术期对危险因素采取针对性干预策略,有助于改善患者术后低氧血症的发生率并促进良性临床转归。Objectives To explore the independent risk factors of postoperative hypoxemia for patients with Stanford type A aortic dissection and assess the influence on the clinical outcome due to postoperative hypoxemia.Methods A total of 109 patients with Stanford type A aortic dissection admitting in The First Affiliated Hospital of Anhui Medical University from December 2018 to June 2023 were selected as the subjects.The patients were divided into hypoxemia group and non-hypoxemia group according to whether the hypoxemia occured after surgery.Firstly,preoperative and intraoperative data of the patients were analyzed by univariate analysis,after that,the variables with statistical significance were analyzed by Logistic regression,and finally the independent risk factors for postoperative hypoxemia were definite.Results There were 45 and 64 patients in hypoxemia group and non-hypoxemia group,respectively.Gender(P=0.001),emergency surgery(P=0.015),weight(P=0.000),preoperative blood urea nitrogen(P=0.008)and deep hypothermia cardiac arrest duration(P=0.042)were considered as significant variates after univariate analysis.After Logistic regression,weight(P=0.001),emergency surgery(P=0.004)and deep hypothermia cardiac arrest duration(P=0.015)were identified as the independent risk factors of postoperative hypoxemia.For the observation of clinical outcome,there were significances in the awaking within 12 h after surgery(P=0.000),postoperative reintubation(P=0.017),tracheotomy(P=0.001),dialysis(P=0.032),severe organic injury(P=0.000),leaving intensive care unite(ICU)within 7 days(P=0.000),movement disorder(P=0.016)and self-discharge(P=0.001)between two groups.Conclusions Weight,emergency surgery and deep hypothermia cardiac arrest duration are the independent risk factors of postoperative hypoxemia.Risk factors should be handled proactively during the perioperative period to reduce the incidence of postoperative hypoxemia and improve outcome.

关 键 词：主动脉夹层 低氧血症 体质量 急诊 深低温停循环 

分 类 号：R543.16[医药卫生—心血管疾病]