D-二聚体与对急性A型主动脉夹层手术预后的关系

Analysis of the prognosis of patients with acute type A aortic dissection with D-dimmer

目的:研究D-二聚体(D-dimmer)升高对急性A型主动脉夹层术后是否有一定的影响。方法:从2014年8月至2015年12月,在本中心行A型主动脉夹层手术的患者中,选取术前、术后4h及术后24h血样完整的患者共94例。急性主动脉夹层A型患者给予升主动脉替换+Sun’s或Bentall+Sun’s手术。其中平均年龄(47.20±10.21)岁,男性占78.3%。根据D-二聚体的数值分为A组:D-二聚体<3 000μg/L,B组。结果:A组:共75例患者占79.8%,死亡1例(0.1%),30 d内死亡:14例(18.7%),体外时间(215.19±57.43)min,主动脉阻断时间(129.6±46.97)min,选择脑灌注时间(26.69±10.17)min,B组共19例,占20.2%。死亡1例(5.3%),30天内死亡6例(31.6%)。体外时间:(222.47±40.70)min,主动脉阻断时间(126.58±24.90)min,选择脑灌注时间(28.37±5.51)min。其中术前肌红蛋白指标B组明显高于A组(P=0.00049),B组FBG(P=0.001)及血小板计数(P=0.00003)均低于A组差异有统计学意义。B组的发病时间明显少于A组(P=0.035),差异有统计学意义,术中出血量(P=0.00038),术后总引流量(P=0.044)及止血药物如纤维蛋白酶原(P=0.015),凝血酶原复合物(P=0.0043)方面差异有统计学意义。导致输血量(P=0.035)高于A组,在并发症方面,患者急性肾功能衰竭,应用CRRT有明显差异(P=0.01)。结论:D-DIMER升高会导致术前凝血机制受损,术中及术后出血量大,需要输血量及止血药物增多最终导致急性肾衰竭发生增加。

Objective：To invest the effect of D- dimer on the acute type A aortic dissection after opera- tion. Methods ：From August 2014 to 2015 December,in our center,Blood samples were taken from 94 patients with Aortic dissection surgery before surgery, 4 hours after operation and 24 hours after operation. Patients with acute aortic dissection type A were treated with ascending aorta replacement ＋ sun＇ s＇ or＇ Bentall ± sun ＇ s, the mean age of the patients was （47.20 ±10. 21 ） years old, and the male was 78.3%. According to the Ddimer were divided into the A group： D- dimer 〈 3 000p, g/L B group, D- dimer≥3 000μg/L. Results： A group： a total of 75 patients （79.8%, the death of 1 （0. 1% ）, death within 30 days： 14 （ 18.7% ） and in CRP time： （215.19 ± 57.43）min aortic crossclamping time （129. 6 ± 46. 97 ）rain and cerebral perfusion time selection： （26. 69 ± 10. 17）rain. B group a total of 19, accounting for 20. 2%. Death 1 （5.3%）, 30 days of death 6 （31.6% ）. In CRP time ： （222. 47 ± 40. 70） min, aortic crossclamping time （ 126. 58 ± 24.90） ruin,the choice of cerebral perfusion time ： （28.37 ± 5.51 ） rain. The preoperative myoglobin in group B was significantly higher than that of group A （ P = O. 00049 ） , B group FBG （ P = 0. 001 ） and platelet count （ P = 0. 00003 ） were lower than in group A. There was statistically significant difference. The onset time of group B was significantly lower than that in group A （ P = 0. 035 ） , was statistically significant, intraoperative blood loss （P = 0. 00038 ） and postoperative total loss flow （P = 0. 044） and hemostatic drugs such as plasminogeu （P = 0. 015）, prothrombin complex concentrate （P = 0. 0043） have obvious differences. Result in the amount of blood transfusion （ P = O. 035 ） higher than the A group, in terms of complications, patients with acute renal failure, the use of CRRT has a significant difference （P = 0. 01 ）. Conclusion： D-dimer elevation can lead to impaired preoperative coagulation mechanism, and the amount of bleeding during operation and postoperative bleeding, the need for blood transfusion and the increase in the number of hemostatic drugs eventually lead to an increase in acute renal failure.