CAJ | 학술논문

目的评估欧洲评分Ⅱ是否能够有效预测急性Stanford A型主动夹层孙氏术后机械通气时间,探索孙氏术后机械通气时间延长的危险因素.方法自2009年12月至2012年2月共240例急性Stanford A型主动脉夹层的患者纳入研究.术后呼吸机机械通气时间超过48 h定义为机械通气时间延长.计算所有患者的欧洲评分.欧洲评分的区分能力采用受试者工作特征(ROC)曲线评估,校正能力采用Hosmer-Lemeshow拟合优度检验评估.结果急性Stanford A型主动脉夹层孙氏术后院内总体病死率为10.0％ (24/240),术后平均呼吸机机械通气时间为17.0(12.5,56.0)h.共74例患者术后机械通气时间延长.欧洲评分Ⅱ的区分能力(ROC曲线下面积=0.52)及校正能力(Hosmer-Lemeshow,P＜0.05)均不佳.单因素分析结果显示年龄[比值比(OR)=2.88,P=0.00]、脑卒中病史(OR=1.04,P=0.03)、外周血白细胞计数(OR =3.19,P=0.00)、发病至手术时间小于1周(OR=3.68,P=0.001)、体外循环时间(OR=1.96,P=0.02)为术后院内死亡的危险因素.Logistic多因素分析年龄大于48.5岁(OR=3.85,P=0.00)、术前外周静脉血白细胞计数超过13.5×109/L(OR=4.05,P=0.00)、发病至手术时间小于1周(OR=3.75,P=0.002)是孙氏术后机械通气时间延长的危险因素.结论年龄、术前白细胞计数超过13.5×109/L、发病至手术时间小于1周是孙氏手术后机械通气时间延长的危险因素.欧洲评分Ⅱ不能有效预测急性Stanford A型夹层孙氏手术后机械通气时间延长.术前及术中采取措施减少外周血白细胞计数、减轻炎性反应可能是一种潜在的主动脉手术脏器保护策略.
목적 평고구주평분Ⅱ시부능구유효예측급성Stanford A형주동협층손씨술후궤계통기시간,탐색손씨술후궤계통기시간연장적위험인소.방법 자2009년12월지2012년2월공240례급성Stanford A형주동맥협층적환자납입연구.술후호흡궤궤계통기시간초과48 h정의위궤계통기시간연장.계산소유환자적구주평분.구주평분적구분능력채용수시자공작특정(ROC)곡선평고,교정능력채용Hosmer-Lemeshow의합우도검험평고.결과 급성Stanford A형주동맥협층손씨술후원내총체병사솔위10.0％ (24/240),술후평균호흡궤궤계통기시간위17.0(12.5,56.0)h.공74례환자술후궤계통기시간연장.구주평분Ⅱ적구분능력(ROC곡선하면적=0.52)급교정능력(Hosmer-Lemeshow,P＜0.05)균불가.단인소분석결과현시년령[비치비(OR)=2.88,P=0.00]、뇌졸중병사(OR=1.04,P=0.03)、외주혈백세포계수(OR =3.19,P=0.00)、발병지수술시간소우1주(OR=3.68,P=0.001)、체외순배시간(OR=1.96,P=0.02)위술후원내사망적위험인소.Logistic다인소분석년령대우48.5세(OR=3.85,P=0.00)、술전외주정맥혈백세포계수초과13.5×109/L(OR=4.05,P=0.00)、발병지수술시간소우1주(OR=3.75,P=0.002)시손씨술후궤계통기시간연장적위험인소.결론 년령、술전백세포계수초과13.5×109/L、발병지수술시간소우1주시손씨수술후궤계통기시간연장적위험인소.구주평분Ⅱ불능유효예측급성Stanford A형협층손씨수술후궤계통기시간연장.술전급술중채취조시감소외주혈백세포계수、감경염성반응가능시일충잠재적주동맥수술장기보호책략.
Objective To assess the performance of EuroSCORE Ⅱ in the prediction of prolonged mechanical ventilation after total aortic arch replacement treating acute Stanford Type A aortic dissection,and to evaluate the risk factors for prolonged mechanical ventilation.Methods From December 2009 to February 2012,240 patients who underwent total aortic arch replacement for acute Stanford type A aortic dissection were analyzed retrospectively.More than 48 hours of mechanical ventilation after the surgery was defined as postoperative prolonged mechanical ventilation.EuroSCORE Ⅱ was used to predict prolonged mechanical ventilation.A receiver operating characteristic (ROC) curve was used to test the discrimination of the model.Calibration was assessed with a Hosmer-Lemeshow goodness-of-fit statistics.Multiple logistic regression analysis was used to identify the final risk factors of prolonged mechanical ventilation.Results The overall mortality was 10.0％ (24/240).The mean length of mechanical ventilation after total aortic arch replacement was 17.0(12.5,56.0) hours.74 of 240 patients needed prolonged mechanical ventilation.EuroSCORE Ⅱ showed that poor discriminatory ability (ROC curve was 0.52) and calibration (Hosmer-Lemeshow,P ＜ 0.05) could predict prolonged mechanical ventilation.With multivariate analysis,independent risk factors for postoperative prolonged mechanical ventilation were age ≥ 48.5 years [odds ratio(OR) =3.85,P ＜0.01],preoperative leukocyte count of ≥ 13.5 × 109/L (OR =4.05,P ＜0.01)and symptom onset before the surgery less than one week (OR =3.75,P =0.002).Conclusions EuroSCORE Ⅱ does not predict prolonged mechanical ventilation following total aortic arch replacement for acute Stanford type A aortic dissection.Preoperative high level of leukocyte,age and surgical period from symptom onset are risk factors for prolonged mechanical ventilation.