A型主动脉夹层术后并发消化道出血相关危险因素分析

Related risk factors of postoperative hemorrhage of digestive tract in type A aortic dissection

目的探讨A型主动脉夹层术后并发消化道出血的相关危险因素。方法回顾性选择2012年10月至2015年4月在新疆维吾尔自治区人民医院行A型主动脉夹层手术治疗的患者25例，观察所有患者术后消化道出血情况。采用多因素Logistic回归模型分析影响术后消化道出血的相关危险因素。结果根据术后是否出现消化道出血分为消化道出血组（10例）和无消化道出血组（15例）。消化道出血组机械通气时间〉5d、心脏指数〈3、肺部感染、低血小板血症、急性肾功能不全、肝功能不全、体外循环时间〉150min例数分别为10、5、10、10、9、10、10例；无消化道出血组分别为3、1、2、2、3、3、2例，消化道出血组上述指标明显多于无消化道出血组，差异均有统计学意义（均P〈0．05）。多元Logistic回归分析显示，机械通气时间〉5d、低血小板血症、急性肾功能不全、体外循环时间〉150min是消化道出血的相关危险因素（比值比=9．69、10．80、33．20、41．20，均P〈0．05）。结论机械通气时间〉5d、低血小板血症、急性肾功能不全、体外循环时间〉150min是A型主动脉夹层术后并发消化道出血的相关危险因素。

Objective To explore the related risk factors of postoperative hemorrhage of digestive tract in type A aortic dissection. Methods Totally 25 patients with type A aortic dissection undergoing surgery from October 2012 to April 2015 were enrolled. The related factors of intraoperative and postoperative gastrointestinal bleeding were analyzed through Logistic regression analysis. Results Gastrointestinal bleeding occurred in 10 cases （gastrointestinal bleeding group）, the other 15 cases were set as non-gastrointestinal bleeding group. There were 10 cases with mechanical ventilation 〉 5 d, 5 cases with cardiac index 〈 3, 10 cases with lung infec- tion, 10 cases with low platelet count, 9 cases with acute renal insufficiency, 10 cases with hepatic insufficiency, 10 cases with duration of extracorporeal circulation time 〉 150 min in gastrointestinal bleeding group, all significantly more than those in non-gastrointestinal bleeding group （3, 1,2, 2, 3, 3,2 cases, al1 P 〈 0. 05）. Logistic regression analysis indicated that mechanical ventilation 〉 5 d, low platelet count, acute renal insufficiency, extra- corporeal circulation time 〉 150 min were the related factors of postoperative gastrointestinal bleeding （odds ratio = 9.69, 10. 80, 33.20, 41.20, all P 〈 0. 05）. Conclusion Mechanical ventilation 〉 5 d, low platelet count, acute renal insufficiency, extracorporeal circulation time 〉 150 min are risk factors of postoperative gastro-intestinal bleeding in type A aortic dissection.