血管活性药物评分与急性Stanford A型主动脉夹层术后预后的相关性研究  

Correlation between vasoactive-inotropic score and prognosis in patients with acute Stanford type A aortic dissection

作　　者：生伟[1] 侯芳霖[2] 赵振桐 邓浩 范坤 池一凡[1] 朱雪 Sheng Wei;Hou Fanglin;Zhao Zhentong;Deng Hao;Fan Kun;Chi Yifan;Zhu Xue(Department of Cardiovascular Surgery,Qingdao Traditional Chinese Medicine Hospital,Qingdao Hiser Hospital Afiliated of Qingdao University,Qingdao 266071,China;Outpatient Department,Qingdao Traditional Chinese Medicine Hospital,Qingd ao Hiser Hospital Affiliated of Qingdao University,Qingdao 266071,China)

机构地区：[1]青岛市中医医院青岛大学附属青岛市海慈医院心脏外科,青岛266071 [2]青岛市中医医院青岛大学附属青岛市海慈医院门诊部,青岛266071

出　　处：《中华胸心血管外科杂志》2025年第4期220-226,共7页Chinese Journal of Thoracic and Cardiovascular Surgery

基　　金：青岛市医药科研指导计划(2019-WJZD012);山东省中医药科技项目面上项目(M-2023033)。

摘　　要：目的:探讨血管活性药物评分(VIS)与急性StanfordA型主动脉夹层(acute Stanford type A aortic dissection,ATAAD)术后30天内病死率的关系。方法:收集2015年11月至2024年5月间接受外科手术治疗的242例ATAAD患者的临床资料。男172例,女70例;年龄28~85岁,平均(53.1±11.9)岁。根据术后30天内生存结局将患者分为死亡组(18例)和生存组(224例)。计算两组患者各时间点VIS,统计围手术期指标。通过多因素分析探讨ATAAD患者术后30天内死亡的预测因素。绘制受试者工作特征曲线(ROC),评价VIS的预测效能。结果:入组ATAAD患者术后30内死亡18例,病死率7.4%。死亡组患者的年龄、心包压塞/心源性休克发生率、脏器灌注不良综合征发生率、体外循环时间、术中及术后24 h红细胞输注量、呼吸机辅助时间、术后严重并发症发生率等均高于生存组,差异有统计学意义,P<0.05。死亡组患者的VIS高于生存组,差异有统计学意义,P<0.05。不同时间点VIS对死亡预测的ROC下面积(AUC)均大于0.500(P<0.05)。ICU第2个24 h的VIS(VISmax48h)的AUC最大(0.906),预测临界值为9,灵敏度0.944,特异度0.821。Logistic回归分析显示,VISmax48h是ATAAD术后30天内死亡的独立危险因素(OR=1.462,95%CI:1.230~1.737,P<0.05)。结论:VISmax48h≥9时ATAAD术后患者死亡风险增高,VISmax48h、体外循环时间、术中及术后24 h红细胞输注量是ATAAD患者术后30天内死亡的独立危险因素。Objective:To investigate the correlation between vasoactive-inotropic score and 30-day mortality after surgery in acute Stanford type A aortic dissection(ATAAD)patients.Methods:The clinical data of 242 patients with ATAAD who underwent surgical treatment was retrospectively analyzed between November 2015 and May 2024.There were 172 males and 70 females.The average age was(53.1±11.9)years,ranging from 28 to 85 years.Patients were divided into death group(18 cases)and survival group(224 cases)according to the 30-day outcomes after surgery.The VIS at different time points and perioperative indexes of two groups of patients were analyzed,and multivariate logistic regression was used to analyze the risk factors of 30-day mortality after surgery in ATAAD patients.The receiver operating characteristic curve(ROC)was drawn to evaluate the predictive value of vasoactive-inotropic score.Results:Among 242 ATAAD patients,18 patients died within 30 days after surgery,with a mortality rate of 7.4%.The age,incidence of pericardial tamponade/cardiogenic shock,incidence of malperfusion syndrome,cardiopulmonary bypass time,red blood cell transfusion intraoperative and in 24 hours postoperatively,ventilator assisted time,and incidence of major postoperative complications of patients in the death group were significantly higher than those in the survival group(P<0.05).The VIS of the death group was significantly higher than that of the survival group at all time points(P<0.05).The area under the receiver operating characteristic curve(AUC)of VIS for predicting death at each time point was greater than 0.500(P<0.05),with the highest AUC(0.906)of the second 24 hours(VISmax48h)in ICU.The optimal cut off value was determined to be 9,with a sensitivity of 0.944 and a specificity of 0.821.Logistic regression analysis showed that the VISmax48h of the second 24 hours in ICU was an independent risk factor for 30-day mortality after surgery in ATAAD patients(OR=1.462,95%CI:1.230-1.737,P<0.05).Conclusion:When VISmax48h≥9,patients with ATAAD

关 键 词：血管活性药物评分 急性StanfordA型主动脉夹层 病死率 

分 类 号：R654.2[医药卫生—外科学]