主动脉夹层患者主动脉全弓置换术后发生压力性损伤的影响因素分析

Analysis of risk factors for pressure injury in patients with aortic dissection after total aortic arch replacement

目的 探讨主动脉夹层患者主动脉全弓置换术后发生压力性损伤(PI)的影响因素。方法 收集2020年1月至2022年12月于江苏省人民医院接受主动脉全弓置换术后发生PI的31例患者的临床资料设为PI组,根据患者年龄与性别采用倾向匹配法按1:2比例选取62例未发生PI的患者设为NPI组。收集两组患者的一般资料、合并疾病、术前检验指标、术中麻醉时间、术后24 h Barthel指数(BI),分析主动脉夹层患者主动脉全弓置换术后发生PI的影响因素。结果 PI组患者术中麻醉时间均长于NPI组患者,白蛋白水平、BI均低于NPI组患者,差异均有统计学意义(P﹤0.05)。多因素分析结果显示,麻醉时间较长为主动脉夹层患者主动脉全弓置换术后发生PI的危险因素(OR≥1,P﹤0.05),白蛋白水平较高、BI较高为主动脉夹层患者主动脉全弓置换术后发生PI的保护因素(OR﹤1,P﹤0.05)。受试者工作特征(ROC)曲线下面积(AUC)显示,术中麻醉时间、白蛋白水平对诊断主动脉夹层患者主动脉全弓置换术后发生PI具有中等预测价值(0.7﹤AUC≤0.9,P﹤0.05),BI对诊断主动脉夹层患者主动脉全弓置换术后发生PI具有较低预测价值(0.5﹤AUC≤0.7,P﹤0.05)。结论 术前白蛋白水平﹤53.08 g/L、术中麻醉时间≥492.50 min、BI﹤76.62均是主动脉夹层患者主动脉全弓置换术后发生PI的危险因素,应完善围手术期相关检查,有针对性地进行PI预防治疗措施,可促进患者术后恢复。

Objective To investigate the risk factors for pressure injury(PI)in patients with aortic dissection after total aortic arch replacement.Method The clinical data of 31 patients who developed PI after total aortic arch replacement at Jiangsu Province Hospital from January 2020 to December 2022 were collected as the PI group.According to the age and gender of the patients,the propensity matching method was used to select 62 patients without PI in a ratio of 1:2 as the NPI group.The general data,comorbid diseases,preoperative test indicators,intraoperative anesthesia time,and Barthel Index(BI)24 hours after surgery were collected from the two groups of patients.The risk factors for PI in patients with aortic dissection after total aortic arch replacement were analyzed.Result The intraoperative anesthesia time and postoperative bed rest time of the patients in the PI group were longer than those of the patients in the NPI group,the albumin level and BI were lower than those of the patients in the NPI group,the differences were statistically significant(P<0.05).Multivariate analysis results showed that longer anesthesia time was the risk factor for PI after total aortic arch replacement in patients with aortic dissection(OR≥1,P<0.05).Higher albumin levels and higher BI were protective factors for PI in patients with aortic dissection after total aortic arch replacement(OR<1,P<0.05).The area under the receiver operating characteristic(ROC)area under the curve(AUC)showed that intraoperative anesthesia time,intraoperative bed rest time,and albumin level had moderate predictive value in diagnosing PI after total aortic arch replacement in patients with aortic dissection(0.7<AUC≤0.9,P<0.05);BI had low predictive value in diagnosing PI in patients with aortic dissection after total aortic arch replacement(0.5<AUC≤0.7,P<0.05).Conclusion Preoperative albumin level<53.08 g/L,intraoperative anesthesia time≥492.50 min,and BI<76.62 are risk factors for PI after total aortic arch replacement in patients with aortic dissection.Relevant perioperative examinations should be improved,and PI preventive and therapeutic measures should be implemented in a targeted manner to promote patients'postoperative recovery.