Stanford A型主动脉夹层术后低氧血症的围手术期危险因素分析

Risk factors for postoperative hypoxemia in patients undergoing Stanford type A aortic dissection surgery

目的 探讨Stanford A型主动脉夹层术后低氧血症的围手术期危险因素。方法 回顾性分析77例Stanford A型主动脉夹层手术患者的临床资料，其中术后发生低氧血症40例（低氧血症组），术后未发生低氧血症37例（非低氧血症组）。比较两组术前、术中、术后的临床资料，并进行多因素Logistic回归分析。结果 Stanford A型主动脉夹层患者术后低氧血症发生率为51.9%（40/77）。多因素Logistic回归分析结果显示，年龄（OR= 1.088，95% CI 1.018~1.164，P= 0.013）、体质量指数≥ 25 kg/m2（OR= 6.495，95% CI 1.327~31.789，P= 0.021）、心包积液（OR= 6.384，95% CI 1.426~28.576，P= 0.015）、白细胞计数（OR= 1.289，95% CI 1.033~1.609，P= 0.024）、使用重组人凝血因子Ⅶa（OR= 23.757，95% CI 2.849~198.085，P= 0.003）是Stanford A型主动脉夹层患者术后发生低氧血症的独立危险因素。结论 Stanford A型主动脉夹层患者术后发生低氧血症与围手术期存在的全身性炎性反应有关，尤其是肥胖患者，术前和术中应积极给予抗炎处理。控制出血，尽可能减少重组人凝血因子Ⅶa的使用，可减少术后低氧血症的发生。

Objective To explore the risk factors for postoperative hypoxemia in patients undergoing Stanford type A aortic dissection surgery.Methods The clinical data of 77 patients with Stanford type A aortic dissection surgery were analyzed retrospectively. Among the patients, 40 patients occurred hypoxemia （hypoxemia group）, and 37 patients did not occur hypoxemia （non- hypoxemia group）. The preoperative, intraoperative and postoperative clinical data were compared between 2 groups, and the independent risk factors for postoperative hypoxemia were analyzed by multiple Logistic regression analysis.Results The incidence of postoperative hypoxemia in patients with Stanford type A aortic dissection was 51.9% （40/77）. The multiple Logistic regression analysis result showed that age （OR= 1.088, 95% CI 1.018-1.164, P= 0.013）, body mass index ≥ 25 kg/m2 （OR= 6.495, 95% CI 1.327- 31.789, P= 0.021）, pericardial effusion （OR= 6.384, 95% CI 1.426-28.576, P= 0.015）, white blood cell count （OR= 1.289, 95% CI 1.033-1.609, P= 0.024） and using recombinant human coagulation Ⅶ a （OR= 23.757, 95% CI 2.849-198.085, P= 0.003） were the independent predictive factors for postoperative hypoxemia in patients with Stanford type A aortic dissection.Conclusions The postoperative hypoxemia in patients with Stanford type A aortic dissection is related with perioperative systemic inflammation, especially in obese patients who should be given anti- inflammatory treatment during perioperative period. Control of bleeding and reducing the recombinant human coagulation Ⅶa as far as possible can reduce the incidence of postoperative hypoxemia.