术前健康状态对B型主动脉夹层患者腔内隔绝术预后的影响

Effect of pre-operative health status on outcome of thoracic endovascular aortic repair in patients with type B aortic dissection

目的探讨术前健康状态对B型主动脉夹层患者腔内隔绝术预后的影响。方法回顾性分析1998年9月至2011年12月在我科行腔内隔绝术治疗的328例B型主动脉夹层患者的临床资料,根据美国麻醉学家学会(ASA)分级将患者分为术前健康状况较差组(ASA>3)和健康状况轻度减低组(ASA≤3),通过对组间术前一般资料差异性检验,结合多因素Cox比例风险模型分析,比较组间术后结果差异。结果围手术期间,组间并发症率差异无统计学意义;随访期间,虽然组间全因死亡率和转开放手术的风险相似,但ASA>3的患者再次腔内隔绝术的风险比ASA≤3的患者高(多因素分析Hazardratio=2.50,95%CI:1.05～5.91,P=0.037)。结论主动脉腔内隔绝术是治疗B型主动脉夹层的一种安全选择。患者术前健康状态可以作为术后中远期结果的一个独立预测指标,正确选择健康状况较好的患者进行腔内隔绝术手术是恰当、可行的。

Objective To evaluate the effect of the pre-operative health status on outcome of thoracic endovascular aortic repair （TEVAR） in patients with type B aortic dissection （T, AD）. Methods The clinical data of 328 TBAD patients, who underwent TEVAR between September 1998 and December 2011, were retrospectively analyzed. The patients were divided into ASA≤3 group and ASA〉3 group according to American Society of Anesthesiologists （ASA） classification before TEVAR. Univariable and multivariate Cox proportional hazard regression model analysis were used to evaluate the difference in outcomes of patients in the two groups. Results There was no significant difference in the complication rates between the two groups during the peri-operation period. During follow-up, the all cause mortality rates and risks of transferring to open operation were similar between the two groups; however, patients in ASA〉3 group had a significantly higher re-TEVAR rate than those in ASA≤3 group （Hazard ratio：2. 50, 95% CI： 1.05 5.91, P=0. 037）. Conclusion TEVAR is a safe alternative for TBAD patients. Poor pre-operative health status has negative effect on the postoperative outcome of TEVAR. Patients with a good health status are suitable for TEVAR.