急性主动脉夹层患者围手术期凝血功能指标与肺损伤的关系  

Relationship between perioperative coagulation function and lung injury in patients with acute aortic dissection

作　　者：刘健[1] 宋朝国 任春梅[1] Liu Jian;Song Chaoguo;Ren Chunmei(Department of Cardiovascular Surgery,Handan Central Hospital,Handan 056008,Hebei,China)

机构地区：[1]邯郸市中心医院心血管外科,河北邯郸056008

出　　处：《血管与腔内血管外科杂志》2025年第3期312-318,共7页Journal of Vascular and Endovascular Surgery

基　　金：2020河北省医学科学研究课题(20200474)。

摘　　要：目的探讨急性主动脉夹层患者围手术期发生肺损伤的独立危险因素及其与凝血功能指标的关系。方法收集2018年2月至2022年2月邯郸市中心医院接受急性主动脉夹层大血管手术治疗的96例患者的临床资料,按照围手术期是否出现肺损伤将其分为肺损伤组(n=46)和非肺损伤组(n=50)。比较两组患者的临床特征、围手术期氧合指数(OI)、凝血指标,采用局部加权回归散点平滑方法(LOWESS)分析OI与凝血指标之间的曲线关系,采用Logistic回归模型分析急性主动脉夹层患者围手术期发生肺损伤的危险因素,据此构建围手术期肺损伤风险预测模型并对其进行评价。结果两组患者围手术期各时间OI均呈逐渐降低趋势,且肺损伤组患者各时间OI均低于非肺损伤组患者,差异均有统计学意义(P﹤0.05)。多因素分析结果显示,凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)均是急性主动脉夹层患者围手术期T1期发生肺损伤的独立危险因素(P﹤0.05),抗凝血酶Ⅲ(ATⅢ)是急性主动脉夹层患者围手术期T_(2)期发生肺损伤的独立危险因素(P﹤0.05),D-二聚体(D-D)是急性主动脉夹层患者整个围手术期发生肺损伤的独立危险因素;年龄、高血压史、手术时间、体外循环(CPB)时间均是急性主动脉夹层患者发生肺损伤的独立危险因素(P﹤0.05)。LOWESS方法分析结果显示,OI与PT、D-D、ATⅢ含量均具有一定的非线性关系。根据上述危险因素构建的预测列线图模型具有较好的区分度、校准度、灵敏度及特异度。结论年龄、高血压史、手术时间、CPB时间、凝血指标PT、APTT、D-D、ATⅢ均是急性主动脉夹层患者围手术期发生肺损伤的危险因素。临床需重点关注上述危险因素,并给予预防治疗,积极控制疾病进展,从而改善患者预后情况。Objective To investigate the independent risk factors of perioperative lung injury in patients with acute aortic dissection and their relationship with coagulation function.Method Clinical data of 96 patients who received acute aortic dissection surgery in Handan Central Hospital from February 2018 to February 2022 were collected,they were divided into lung injury group(n=46)and non-lung injury group(n=50)according to whether they had lung injury during perioperative period.The clinical characteristics,perioperative oxygenation index(OI)and coagulation indexes of the two groups were compared.The curve relationship between OI and coagulation indexes was analyzed by locally weighted scatterplot smoothing(LOWESS).The risk factors of perioperative lung injury in patients with acute aortic dissection were analyzed by Logistic regression model.The prediction model of perioperative lung injury risk was established and evaluated.Result Perioperative OI in two groups showed the gradually decreasing trend at all times,and OI in lung injury group was lower than that in non-lung injury group at all times,with statistical significance(P<0.05).The results of multi-factor analysis showed that prothrombin time(PT)and activated partial thromboplastin time(APTT)were independent risk factors for pulmonary injury in patients with acute aortic dissection during perioperative T1 period(P<0.05).Antithrombin III(ATIII)was an independent risk factor for lung injury AT perioperative T_(2) in patients with acute aortic dissection(P<0.05),and D-dimer(D-D)was an independent risk factor for lung injury at perioperative T_(2) in patients with acute aortic dissection.Age,history of hypertension,duration of operation and duration of cardiopulmonary bypass(CPB)were independent risk factors for lung injury in patients with acute aortic dissection(P<0.05).LOWESS method showed that OI had a nonlinear relationship with PT,D-D concentration and ATIII content.The prediction nomogram model based on the above risk factors has good differentiation,calibra

关 键 词：急性主动脉夹层 肺损伤 危险因素 预测模型 凝血指标 

分 类 号：R543[医药卫生—心血管疾病]