柏林定义在Stanford A型主动脉夹层患者术后急性呼吸窘迫综合征中的应用  

Application of the Berlin definition to postoperative acute respiratory distress syndrome in patients with Stanford Type A aortic dissection

作　　者：蔡腾 杨宁 马冬纹[1] 王杰[3] 蔡国强[1] 费忠化[1] 杨成会 Cai Teng;Yang Ning;Ma Dongwen;Wang Jie;Cai Guoqiang;Fei Zhonghua;Yang Chenghui(Cardiac Intensive Care Unit,the Affiliated Hospital of Jining Medical University,Jining 272029,China;Health Management and Service Center,the Affiliated Hospital of Jining Medical University,Jining 272029,China;Department of Medical Laboratory,the Affiliated Hospital of Jining Medical University,Jining 272029,China;College of Clinical Medicine,Jining Medical University,Jining 272013,China)

机构地区：[1]济宁医学院附属医院心脏重症医学科,济宁272029 [2]济宁医学院附属医院健康管理与服务中心,济宁272029 [3]济宁医学院附属医院医学检验科,济宁272029 [4]济宁医学院临床医学院,济宁272013

出　　处：《中国医师杂志》2024年第12期1773-1777,1783,共6页Journal of Chinese Physician

基　　金：山东省自然科学基金(ZR2021MH346);济宁市重点研发计划(2023YXNS155)。

摘　　要：目的探讨柏林定义对Stanford A型主动脉夹层(AAD)患者术后发生急性呼吸窘迫综合征(ARDS)临床结局的判断价值。方法共纳入2016年1月至2021年12月济宁医学院附属医院诊断为AAD且接受手术治疗的212例患者,术后基于ARDS柏林定义将患者分为ARDS组和非ARDS组。单因素分析比较两组患者术前一般临床资料,筛选倾向性匹配变量,采用倾向匹配评分将患者分为ARDS组(n=63)和非ARDS组(n=63),比较匹配后ARDS组和非ARDS组临床结局指标。结果AAD术后共63例(29.7%)患者诊断为ARDS。采用倾向性评分调整术前混杂因素,共63对患者匹配成功。匹配后,ARDS组患者全弓手术占比、手术时间及围手术期出血量、输注红细胞量、输注血浆量显著高于非ARDS组,差异均有统计学意义(均P<0.05)。匹配后,ARDS组患者急性生理和慢性健康状况Ⅱ(APACHEⅡ)评分[18(14-24)分vs 13(12-15)分]、机械通气时间[86.0(57.3-158.0)h vs 41.5(23.8-60.4)h]、ICU停留时间[7.0(6.0-11.5)d vs 4.0(3.0-6.0)d]、住院时间[18.0(14.0-24.5)d vs 13.5(10.8-18.0)d]显著高于非ARDS组,差异均有统计学意义(均P<0.05)。两组院内病死率(3.2%vs 1.6%)及出院30 d内病死率(6.3%vs 3.2%)比较,差异均无统计学意义(均P>0.05)。结论基于柏林定义诊断AAD患者术后ARDS发生率较高,但ARDS组院内及出院30 d内病死率并未增加。ARDS柏林定义对AAD患者术后ARDS应用可能有一定局限性。ObjectivesTo evaluate the clinical outcome of acute respiratory distress syndrome(ARDS)in patients with Stanford Type A aortic dissection(AAD).MethodsA total of 212 patients diagnosed with AAD and receiving surgical treatment in the Affiliated Hospital of Jining Medical University from January 2016 to December 2021 were included.The patients were divided into ARDS group and non-ARDS group based on the definition of ARDS Berlin after surgery.The preoperative general clinical data of the two groups were compared by univariate analysis,and the preference-matching variables were screened.The patients were divided into ARDS group(n=63)and non-ARDS group(n=63)by using propensity matching score,and the clinical outcome indexes of ARDS group and non-ARDS group were compared after matching.ResultsA total of 63 patients(29.7%)were diagnosed with ARDS after AAD.A total of 63 pairs of patients were successfully matched using propensity score to adjust preoperative confounding factors.After matching,the proportion of total arch surgery,operation time,perioperative blood loss,red blood cell transfusion and plasma transfusion in the ARDS group were significantly higher than those in the non-ARDS group,with statistical significance(all P<0.05).After the match,In the ARDS group,Acute Physiology and Chronic Health EvaluationⅡ(APACHEⅡ)score[18(14-24)points vs 13(12-15)points],mechanical ventilation time[86.0(57.3-158.0)h vs 41.5(23.8-60.4)h],intensive care unit(ICU)stay time[7.0(6.0-11.5)d vs 4.0(3.0-6.0)d]and hospital stay[18.0(14.0-24.5)d vs 13.5(10.8-18.0)d]were significantly higher than those in the non-ARDS group,with statistical significance(all P<0.05).There was no significant difference in in-hospital mortality(3.2%vs 1.6%)or within 30 days after discharge(6.3%vs 3.2%)between the two groups(all P>0.05).ConclusionsThe incidence of ARDS is higher in patients diagnosed with AAD based on the Berlin definition,but there is no increase in the mortality rate within 30 days of hospital and discharge in ARDS group.The Berlin def

关 键 词：主动脉疾病 动脉夹层 呼吸窘迫综合征 

分 类 号：R654.3[医药卫生—外科学] R563.8[医药卫生—临床医学]