重度全身炎性反应综合征对全主动脉弓置换术后早期临床结局的影响

Relationship Between Severe Systemic Inflammatory Response Syndrome and In-hospital Outcomes In Patients After Total Aotic Arch Replacement

目的回顾性分析深低温停循环全主动脉弓置换术患者的临床资料,探索重度全身炎性反应综合征(SIRS)对全主动脉弓置换术后早期临床结局的影响。方法通过分析我院2013年5月至2014年12月全部深低温停循环下行全主动脉弓置换术患者的临床数据,根据术后48小时内SIRS评分,将患者分为非重度组(N组,SIRS评分≤3分)和重度组(S组,SIRS评分为4分),比较两组患者术后住院期间各种并发症的发生情况,分析重度SIRS对全主动脉弓置换术后早期各项临床结局的影响。结果共入选269例患者,男性196例(72.8%),术后有104例(38.6%)发生重度SIRS。与非重度SIRS组相比,重度SIRS组术后机械通气时间(82.6±22.1h vs 37.4±15.0 h,P=0.011)、ICU停留时间(7.2±6.1d 3.8±2.2d,P<0.001)及住院时间(14.7±10.9d vs 12.1±6.5d,P=0.006)明显延长;且两组在院内死亡率(1.1%vs 4.9%,P<0.05),血液透析发生率(7.8%vs 20.1%,P<0.01),肺部感染发生率(19.8%vs 40.9%,P<0.01),二次插管(2.8%vs 9.8%,P<0.01),气管切开(0.6%vs 6.7%,P<0.01),消化道出血(2.0%vs 6.1%,P<0.05)方面有明显的统计学差异;而两组患者脑卒中(1.4%vs 3.7%,P=0.18)、截瘫(2.5%vs 5.5%,P=0.084)、谵妄(2.8%vs 5.5%,P=0.127)、二次开胸止血(3.1%vs 4.9%,P=0.307)发生率无明显差异。结论重度SIRS在深低温停循环下全主动脉弓置换术后的发生率较高(38.6%),并延长患者术后机械通气时间、ICU停留时间及住院时间,明显增加住院期间死亡、肺部感染、血滤、二次气管插管、气管切开、消化道出血的发生率。

Objective To analyze the relationship between severe systemic inflammatory response syndrome and in-hospital outcomes in patients after total aotic arch replacement. Methold 269 patients undergoing total aotic arch replacement under deep hypothermic circulatory arrest between May 2013 and December 2014 were retrospectively studied. According to SIRS score within 48 hours after operation,patients were divided into 2 groups, the group of severe SIRS（meet 4 criterias） and the group of non-severe SIRS（others）.The baseline characters and postoperation complications were recorded. Result Totally 269 patients were included.196（72.8%）were men. 104（38.6%） patients after total aotic arch replacement under deep hypothermic circulatory arrest developed severe SIRS. Compared to the non-severe SIRS group, the severe SIRS group showed significant longer duration of mechanical ventilatin（82.6±22.1 h vs 37.4±15.0 h, P=0.011）, ICU stay（7.2±6.1 d 3.8±2.2 d, P〈0.001）and hospital stay（14.7±10.9 d vs 12.1±6.5 d, P=0.006）. And also showed higher motality（1.1% vs 4.9%, P〈0.05）, hemodialysis（7.8% vs 20.1%, P〈0.01）,pulmonary infection（19.8% vs 40.9%, P〈0.01）,reintubation（2.8% vs 9.8%, P〈0.01）, tracheotomy（0.6% vs 6.7%, P〈0.01）, gastrointestinal hemorrhage（2.0% vs 6.1%, P〈0.05）. But no significant difference on stroke（1.4% vs 3.7%, P =0.18）, paraplegia（2.5% vs 5.5%, P =0.084）, delirium（2.8% vs 5.5%, P =0.127）, reoperation（3.1% vs 4.9%, P =0.307）. Conclusion Severe SIRS after total aotic arch replacement under deep hypothermic circulatory arrest is associated with increasing motality,hemodialysis,pulmonary infection,reintubation,tracheotomy,gastrointestinal hemorrhage and also prolonging the duration of ICU stay and hospital stay.