中华胸心血管外科杂志
中華胸心血管外科雜誌
중화흉심혈관외과잡지
Chinese Journal of Thoracic and Cardiovascular Surgery
2011年
6期
349-352
,共4页
尚蔚%刘楠%闫晓蕾%孙立忠%贾士杰
尚蔚%劉楠%閆曉蕾%孫立忠%賈士傑
상위%류남%염효뢰%손립충%가사걸
动脉瘤,夹层/外科学%急性呼吸功能不全%危险因素
動脈瘤,夾層/外科學%急性呼吸功能不全%危險因素
동맥류,협층/외과학%급성호흡공능불전%위험인소
Aortic aneurysm%dissection/surgery Acute respiratory dysfunction Risk factors
目的 分析Stanford A型主动脉夹层手术后病人发生急性呼吸功能不全(ARD)的相关危险因素,为制定预防和治疗措施提供依据.方法 2009年2月至2010年10月在深低温(鼻温降至18℃)停循环下行主动脉替换术的A型主动脉夹层病例252例,其中男193例,女59例;平均年龄(47±11)岁.术前诊断急性A型夹层187例(发病＜2周),慢性A型夹层65例.记录病人的年龄、性别、术前合并症、既往主动脉手术史、主动脉夹层类型、有无灌注不良综合征、手术方式、体外循环转流时间和术后并发症.监测术前及术后的血气分析、胸部X线平片、呼吸机参数及术中和术后24 h输血、输液数量.对术后ARD发生的相关危险因素进行单因素分析及多因素logistic回归分析.结果 32例(12.7%)术后早期(＜72 h)出现ARD.ARD组和非ARD组住院病死率差异有统计学意义(P＜0.05).ARD组体重指数、急性夹层所占比例、术前收缩压、体外循环和主动脉阻断时间、全弓置换手术明显高于非ARD组,术中红细胞压积明显低于非ARD组(P＜0.05).多元logistic回归分析显示,术中及术后24 h内输浓缩红细胞＞10 U及体外循环转流时间＞160 min是ARD的独立危险因素.结论 A型主动脉夹层手术后早期ARD与住院病死率相关,术中及术后24 h内输浓缩红细胞＞10 U和体外循环转流时间＞160 min是术后早期ARD的独立危险因素.
目的 分析Stanford A型主動脈夾層手術後病人髮生急性呼吸功能不全(ARD)的相關危險因素,為製定預防和治療措施提供依據.方法 2009年2月至2010年10月在深低溫(鼻溫降至18℃)停循環下行主動脈替換術的A型主動脈夾層病例252例,其中男193例,女59例;平均年齡(47±11)歲.術前診斷急性A型夾層187例(髮病＜2週),慢性A型夾層65例.記錄病人的年齡、性彆、術前閤併癥、既往主動脈手術史、主動脈夾層類型、有無灌註不良綜閤徵、手術方式、體外循環轉流時間和術後併髮癥.鑑測術前及術後的血氣分析、胸部X線平片、呼吸機參數及術中和術後24 h輸血、輸液數量.對術後ARD髮生的相關危險因素進行單因素分析及多因素logistic迴歸分析.結果 32例(12.7%)術後早期(＜72 h)齣現ARD.ARD組和非ARD組住院病死率差異有統計學意義(P＜0.05).ARD組體重指數、急性夾層所佔比例、術前收縮壓、體外循環和主動脈阻斷時間、全弓置換手術明顯高于非ARD組,術中紅細胞壓積明顯低于非ARD組(P＜0.05).多元logistic迴歸分析顯示,術中及術後24 h內輸濃縮紅細胞＞10 U及體外循環轉流時間＞160 min是ARD的獨立危險因素.結論 A型主動脈夾層手術後早期ARD與住院病死率相關,術中及術後24 h內輸濃縮紅細胞＞10 U和體外循環轉流時間＞160 min是術後早期ARD的獨立危險因素.
목적 분석Stanford A형주동맥협층수술후병인발생급성호흡공능불전(ARD)적상관위험인소,위제정예방화치료조시제공의거.방법 2009년2월지2010년10월재심저온(비온강지18℃)정순배하행주동맥체환술적A형주동맥협층병례252례,기중남193례,녀59례;평균년령(47±11)세.술전진단급성A형협층187례(발병＜2주),만성A형협층65례.기록병인적년령、성별、술전합병증、기왕주동맥수술사、주동맥협층류형、유무관주불량종합정、수술방식、체외순배전류시간화술후병발증.감측술전급술후적혈기분석、흉부X선평편、호흡궤삼수급술중화술후24 h수혈、수액수량.대술후ARD발생적상관위험인소진행단인소분석급다인소logistic회귀분석.결과 32례(12.7%)술후조기(＜72 h)출현ARD.ARD조화비ARD조주원병사솔차이유통계학의의(P＜0.05).ARD조체중지수、급성협층소점비례、술전수축압、체외순배화주동맥조단시간、전궁치환수술명현고우비ARD조,술중홍세포압적명현저우비ARD조(P＜0.05).다원logistic회귀분석현시,술중급술후24 h내수농축홍세포＞10 U급체외순배전류시간＞160 min시ARD적독립위험인소.결론 A형주동맥협층수술후조기ARD여주원병사솔상관,술중급술후24 h내수농축홍세포＞10 U화체외순배전류시간＞160 min시술후조기ARD적독립위험인소.
Objective Acute respiratory dysfunction (ARD) can occur after aortic surgery with the use of cardiopulmonary bypass and deep hypothermic circulation arrest, but relatively little is known about acute respiratory dysfunction in the patients with type A aortic dissection. This study aims to analyze the independent risk factors of acute respiratory dysfunction after A type aortic dissection surgery and to assess possible prevention and treatment option in the future. Methods Clinical data of the 252 patients including 193 male patients and 59 female patients who underwent type A aortic dissection surgery from February 2009 to October 2010 were collected. The mean age was 47 years. Postoperative acute respiratory dysfunction was defined as oxygenation impairment (PaO2/FiO2 ＜ 150) that occurred within 72 h of surgery except pleural effusion, cardiogenic pulmonary edema, pneumonia, pulmonary embolism and haemato-/ pneumothorax. There were 187 acute A type aortic dissection patients and 65 chronic type A aortic dissection patients. Clinical characteristics including age, gender, weight, height, history of hypertension, history of smoking, preoperative complications such as preoperative shock and acute renal failure, pericardial effusion, previous cardiac surgery, time from event to surgery, malperfusion syndrome, cardiopulmonary time, cross-clamp time,deep hypothermia circulation arrest time, surgical procedure, duration of intensive care unit stay and postoperative complications including tracheotomy, dialysis dependent renal failure and hospital mortality were gathered. Arterial blood analysis, chest X ray, ventilator parameters, number of blood transfusion and flood balance were assayed after operation. All the factors were evaluated by means of univariate and multivariate logistic regression analysis to identify relative risk factors of ARD. Results Acute respiratory dysfunction occurred in 32 (12.7% ) patients. The in-hospital mortality was significant difference between acute respiratory dysfunction group and non- acute respiratory dysfunction group (P ＜ 0.05). The value of BMI, incidence of acute aortic dissection, preoperative SBP level, cardio-pulmonary bypass time, aortic clamp time and total arch replacement in acute respiratory dysfunction group were significantly higher than the values in non- acute respiratory dysfunction group. Multivariate Logistic regression analysis showed blood transfusion more than 10 units and cardio-pulmonary bypass time more than 160 minutes were independent risk factors of early stage acute respiratory dysfunction after type A aortic dissection surgery.Conclusion Acute respiratory dysfunction after type A aortic dissection was a severe early stage postoperative complication and was associated with in-hospital mortality. The patients in acute aortic dissection were prone to have acute respiratory dysfunction. The independent risk factors of acute respiratory dysfunction included blood transfusion more than 10 units and cardio-pulmonary bypass time more than 160 minutes.
