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[1]梁永福,赵博,梁飞.急性A型主动脉夹层全主动脉弓置换术后死亡的危险因素分析[J].天津医科大学学报,2021,27(02):155-158.
 LIANG Yong-fu,ZHAO Bo,LIANG Fei.Analysis of risk factors for death after acute type A aortic dissection after total aortic arch replacement[J].Journal of Tianjin Medical University,2021,27(02):155-158.
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急性A型主动脉夹层全主动脉弓置换术后死亡的危险因素分析(PDF)
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《天津医科大学学报》[ISSN:1006-8147/CN:12-1259/R]

卷:
27
期数:
2021年02期
页码:
155-158
栏目:
临床医学
出版日期:
2021-03-15

文章信息/Info

Title:
Analysis of risk factors for death after acute type A aortic dissection after total aortic arch replacement
文章编号:
1006-8147(2021)02-0155-04
作者:
梁永福赵博梁飞
(南阳市第二人民医院心脏大血管外科,南阳 473012)
Author(s):
LIANG Yong-fuZHAO BoLIANG Fei
(Department of Cardiovascular Surgery,Nanyang Second People′s Hospital,Nanyang 473012,China)
关键词:
Stanford A型主动脉夹层全主动脉弓置换术危险因素
Keywords:
Stanford type A aortic dissection total aortic arch replacement risk factors
分类号:
R543.1
DOI:
-
文献标志码:
A
摘要:
目的:分析急性A型主动脉夹层(ATAAD)全主动脉弓置换术后死亡的危险因素。方法:收集2016年1月—2020年5月在南阳市第二人民医院行全主动脉弓置换的ATAAD患者134例。根据患者入院30 d后的生存情况,将患者分为死亡组(30例)和存活组(104例),比较两组患者的一般临床资料、术中情况和术后情况。Cox回归分析影响患者死亡的危险因素,受试者工作特征(ROC)曲线检测血管活性药物评分(VIS)对患者30 d内死亡的预测价值。结果:两组患者入院时的一般临床资料差异均无统计学意义。死亡组手术时间、体外循环时间、术后气管切开、发生心脏骤停、急性呼吸功能不全、永久性神经系统并发症(PND)、肾功能不全和肝功能不全患者比例均高于存活组(U/χ2=9.415、5.417、5.783、13.533、5.486、11.734、8.798、4.742,均P <0.05),死亡组呼吸机辅助时间、ICU停留时间、手术结束时及术后12、24和48 h时的VIS均高于存活组(U=6.021、7.301、4.021、6.302、7.014,均P <0.05)。Cox回归分析结果显示,术后心脏骤停、急性呼吸功能不全、肾功能不全和术后48 h VIS为影响患者术后30 d内死亡的危险因素[OR =1.047(95% CI:1.060~1.475)、4.528(95% CI:1.206~9.627)、1.685(95% CI:1.207~5.623)、6.284(95% CI:2.617~15.201),均P <0.05]。ROC曲线显示,术后48 h VIS评估患者术后30 d内死亡的截断值为8分,曲线下面积为8.452,95% CI:8.140~8.953,敏感性为75.4%,特异性为87.3%。结论:ATAAD全主动脉弓置换术后出现心脏骤停、急性呼吸功能不全和术后48 h VIS≥8分均为预测患者术后30 d内死亡的有效指标。
Abstract:
Objective: To analyze the risk factors of death after total aortic arch replacement in acute type A aortic dissection (ATAAD).Methods: A collection of 134 patients with ATAAD who underwent total aortic arch replacement in our hospital from January 2016 to May 2020.According to the survival status of patients 30 days after admission,the patients were divided into death group(30 cases) and survival group (104 cases),and the general clinical data,intraoperative and postoperative conditions of the two groups were compared. Cox regression analysis of risk factors affecting patient death,receiver operating characteristic(ROC) curve to detect the predictive value of vasoactive drug score(VIS) in patients with death within 30 days. Results: There was no significant difference in the general clinical data of the two groups at the time of admission.The proportion of patients in the death group with operation time,extracorporeal circulation time,postoperative tracheotomy,cardiac arrest,acute respiratory insufficiency,permanent neurological complications (PND),renal insufficiency and liver insufficiency were higher than those in the survival group(U/χ2=9.415,5.417,5.783,13.533,5.486,11.734,8.798,4.742,all P <0.05). The ventilator assist time,ICU stay time,VIS at the end of the operation and 12,24 and 48 h after the death group were higher than those in the survival group (U=6.021,7.301,4.021,6.302,7.014,all P <0.05).The results of Cox regression analysis showed that postoperative cardiac arrest,acute respiratory insufficiency,renal insufficiency and VIS score at 48 h after surgery were risk factors for postoperative death[OR =1.047(95%CI:1.060-1.475),4.528(95%CI:1.206-9.627),1.685(95%CI:1.207-5.623),6.284(95%CI:2.617-15.201),all P <0.05].The ROC curve results show that the cut-off value of the VIS score at 48 h after the operation to evaluate the death of the patient within 30 days after the operation is 8,AUC=8.452,95%CI(8.140-8.953),sensitivity was 75.4%,and specificity was 87.3%. Conclusion: Cardiac arrest after ATAAD total aortic arch replacement,acute respiratory insufficiency,and 48 h postoperative VIS score≥8 are all effective indicators for predicting death after 30 days.

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备注/Memo

备注/Memo:
作者简介 梁永福(1969-),男,副主任医师,硕士,研究方向:心脏大血管外科;E-mail:ylyh88866@126.com。
更新日期/Last Update: 2021-03-10