Stanford A型主动脉夹层患者术前肾功能不全对术后重度低氧血症发生的影响

The relationship between preoperative renal failure and severe postoperative hypoxemia of patients received surgical procedures for Stanford A aortic dissection

目的研究Stanford A型主动脉夹层患者肾功能不全与术后低氧血症发生的相关性。方法回顾性分析首都医科大学附属北京安贞医院心外五病房2014年1月至2015年4月连续收治的411例Stanford A型主动脉夹层患者临床资料。记录患者术后48 h内出现重度低氧血症[氧合指数〈100 mmHg（1 mmHg＝0.133 kPa）]的情况，并以此作为主要预后指标，将潜在的预后因素纳入数据库，分别进行单因素分析及多因素Logistic回归分析。将筛选出的独立预后因素中的肾功能相关指标进行分层分析。结果术后48 h内发生重度低氧血症69例，发生率为17.1%。单因素及Logistic回归分析结果均提示，术前内生肌酐清除率不是术后重度低氧血症发生的独立预后因素，而术前血清肌酐浓度是术后重度低氧血症发生的独立预后因素（OR＝1.009，95%CI：1.000-1.018，P＝0.048）。分层分析结果未能明确术前血清肌酐浓度指示术后低氧血症发生的拐点。结论术前反映肾功能的常用指标中，血清肌酐浓度是Stanford A型主动脉夹层患者术后48 h内重度低氧血症发生的独立预后因素，而内生肌酐清除率不是相应的独立预后因素。

ObjectiveTo study the relationship between renal failure and severe postoperative hypoxemia of patients received surgical procedure for Stanford A aortic dissection.MethodsClinical data of 411 consecutive patients from January 2014 to April 2015, who received surgical procedure for Stanford A aortic dissection in Department of Cardiovascular Surgery of Beijing Anzhen Hospital, were collected retrospectively. The appearance of severe postoperative hypoxemia was recorded in all the cases. All the data about potential prognostic factors was put into the database and analyzed by univariate and multivariate Logistic regression respectively.ResultsSevere postoperative hypoxemia （PO2/FiO2〈100 mmHg, 1 mmHg=0.133 kPa） happened on 69 cases within 48 hours after procedures, with the incidence rate of 17.1%. Both univariate and multivariate Logistic regression indicated the influence that preoperative creatinine clearance rate had on severe postoperative hypoxemia showed no statistical significance. However, the influence of preoperative serum creatinine showed statistical significance （OR=1.009, 95%CI： 1.000 to 1.018, P=0.048）.ConclusionsThe preoperative creatinine clearance rate of patients has no direct relationship with severe postoperative hypoxemia. But the preoperative serum creatinine could be regarded as an independent predictor of severe postoperative hypoxemia.