术前症状性心包积液对Stanford A型主动脉夹层患者术后康复的影响

Effects of Symptomatic Pericardial Effusion on the Patients with Stanford Type A Aortic Dissection to Postoperative Rehabilitation

目的统计分析急性主动脉夹层(Stanford A型)患者的病历资料,探讨术前症状性心包积液对患者术后康复的影响。方法统计作者科室重症加强护理病房(intensive care unit,ICU)自2005-06/2017-06月急性主动脉夹层患者的病历资料,抽取63例术前症状性心包积液的患者为症状性心包积液组和同期130例心包积液不合并症状的患者为对照组,对比分析两组患者一般资料及术后多项指标差异。结果症状性心包积液组多巴胺使用剂量、肌钙蛋白I(cardiac troponin I,cTn I)、动脉血气乳酸值(lactic acid,Lac)、胆红素总量(total bilirubin,TBil)、丙氨酸氨基转移酶(alanine aminopeptidase,ALT)、天门冬氨酸氨基转移酶(aspartate aminotransferase,AST)、术后次日B型脑钠肽(brain natriuretic peptide,BNP)、呼吸机辅助时间、连续肾脏替代率(continuous renal replacement therapy,CRRT)使用率、消化道出血发生率、神经系统并发症发生率、住院死亡率、住院费用较对照组明显升高,组间比较差异具有统计学意义(P均<0.05);而症状性心包积液组术后1周左室射血分数(left ventricular ejection fraction,LVEF)、肌酐清除率(creatinine clearance rate,CCR)下降较对照组下降,组间比较差异具有统计学意义(P<0.05);两组心包纵膈引流量比较差异无统计学意义(P>0.05)。结论术前症状性心包积液增加了急性主动脉夹层(Stanford A型)患者术后多器官功能不全发生率及住院费用,延长了患者的康复时间。

Objective To analyze the medical records of patients with acute aortic dissection(Stanford type A) and explore the effect of symptomatic pericardial effusion on postoperative rehabilitation. Methods The medical records of patients with acute aortic dissection in intensive care unit(ICU) of authors hospital from June 2005 to June 2017 were inluded and analyzed. Sixty-three patients have pericardial effusion with symptomatic were selected as the symptomatic pericardial effusion group and 130 patients with pericardial effusion without symptomatic in the same period as the control group. The general data and the differences of various indexes after operation of the two groups were compared.Results Dose of dopamines, cardiac troponin I( cTnI), lactic acid( Lac), total bilirubin( TBil), alanine aminopeptidase(ALT), aspartate aminotransferase(AST), brain natriuretic peptide(BNP), assisted mechanical ventilation time, the utilization rate of continuous renal replacement therapy(CRRT), the incidence rate of gastrointestinal bleeding, the incidence rate of neurological complications, in-hospital mortality, hospitalization expense in pericardial effusion group were significantly higher than those in the control group after operation(all P<0. 05). While the left ventricular ejection fraction(LVEF) at 1 week after operation and creatinine clearance rate(CCR) decrease in pericardial effusion group were lower than those in the control group(P<0. 05). There was no significantly difference in pericardial mediastinal drainage between two groups(P>0. 05). Conclusion Acute aortic dissection with symptomatic pericardial effusion before operation can increase the incidence rate of multiple organ dysfunction, hospitalization expense and the time of rehabilitation.