急性A型主动脉夹层术后神经系统并发症患者预后危险因素分析  

Analysis of prognostic risk factor in patients with neurological complications after acute type A aortic dissection

作　　者：孙遥 杜霞 Sun Yao;Du Xia(Department of Cardiovascular Surgery,the First Affiliated Hospital of Air Force Medical University,Xi'an 710032,Shaanxi,China)

机构地区：[1]空军军医大学第一附属医院心血管外科,陕西西安710032

出　　处：《血管与腔内血管外科杂志》2025年第3期300-305,共6页Journal of Vascular and Endovascular Surgery

基　　金：陕西省自然科学基础研究计划项目(2024JC-YBMS-635)。

摘　　要：目的探讨急性A型主动脉夹层(ATAAD)术后神经系统并发症患者预后的危险因素。方法收集2020年11月至2023年10月于空军军医大学第一附属医院接受手术治疗的182例ATAAD患者的临床资料,根据术后神经系统并发症发生情况将其分为并发组(n=42)与未并发组(n=140)。采用Logistic回归模型分析ATAAD术后发生神经系统并发症的危险因素,经回归方程拟合的概率值绘制受试者工作特征(ROC)曲线,绘制Kaplan-Meier曲线,比较两组患者的累积生存率。结果两组患者年龄、术前肾功能异常、手术时间、单侧脑灌注时间、术后低氧血症、术后左室射血分数(LVEF)、首次重症加强护理病房(ICU)停留时间、术后新发心房颤动、术后肾功能异常比较,差异均有统计学意义(P﹤0.05)。多因素分析结果显示,手术时间、单侧脑灌注时间、首次ICU停留时间、术后新发心房颤动、术后肾功能异常均是ATADD术后发生神经系统并发症的独立危险因素(P﹤0.05)。ROC曲线显示,联合预测的曲线下面积(AUC)、灵敏度、特异度均较高。并发组患者累积生存率为66.67%,低于未并发组患者的82.86%,差异有统计学意义(P﹤0.05)。结论手术时间、单侧脑灌注时间、首次ICU停留时间、术后新发心房颤动、术后肾功能异常均是ATADD术后发生神经系统并发症的独立危险因素,其联合预测对ATADD术后神经系统并发症的预测价值较高,对于具有以上危险因素的患者应及时予相应治疗措施。Objective To investigate the prognosis risk factor for neurological complications in patients after surgery for acute type A aortic dissection(ATAAD).Method The clinical data of 182 ATAAD patients who received surgical treatment at the First Affiliated Hospital of Air Force Medical University from November 2020 to October 2023 were collected.According to the occurrence of postoperative neurological complications,the patients were divided into concurrent group(n=42)and non-concurrent group(n=140).Logistic regression model was used to analyze the risk factors for neurological complications after ATAAD.Receiver operator characteristic(ROC)curve and Kaplan-Meier curve were plotted according to the probability values fitted by the regression equation,and the cumulative survival rate of the two groups was compared.Result There were statistically significant differences in age,preoperative renal dysfunction,operation time,unilateral cerebral perfusion time,postoperative hypoxemia,postoperative left ventricular ejection fraction(LVEF),first intensive care unit(ICU)stay time,postoperative new atrial fibrillation,and postoperative renal dysfunction between the two groups(P<0.05).The results of multivariate analysis showed that operation time,unilateral cerebral perfusion time,first ICU stay time,postoperative new atrial fibrillation,and postoperative renal dysfunction were independent risk factors for neurological complications after ATADD(P<0.05).ROC curve showed that area under curve(AUC),sensitivity and specificity of combined prediction were higher.The cumulative survival rate in the concurrent group was 66.67%,which was lower than that in the non-concurrent group of 82.86%,the difference was statistically significant(P<0.05).Conclusion Operation time,unilateral cerebral perfusion time,first ICU stay time,postoperative new atrial fibrillation,and postoperative renal dysfunction are all independent risk factors for neurological complications after ATADD,and their combined prediction value is high in predicting neurologi

关 键 词：急性A型主动脉夹层 术后神经系统并发症 危险因素 预后 

分 类 号：R543[医药卫生—心血管疾病]