299例急性A型主动脉夹层术后死亡危险因素分析

Risk factors of postoperative hospital death of acute type A aortic dissection:A 299-case study

目的探讨急性A型主动脉夹层患者术后死亡的危险因素。方法回顾性分析2006年8月至2018年9月期间连续手术的299例急性A型主动脉夹层患者,将患者按是否术后死亡分为死亡组(61例)和存活组(238例),详细统计两组患者围术期资料并进行对比,将单因素分析有统计学意义的结果(P <0.05)纳入多因素Logistic回归明确独立危险因素,并采用受试者工作特征曲线(ROC)对所得危险因素的预测效能进行判断。结果单因素分析结果经Logistic回归分析进一步明确:年龄≥50岁、术前伴灌注不良综合征、全弓置换手术方式(孙氏手术)、术后并发低心排是患者院内死亡独立危险因素。ROC曲线显示,联合预测概率的曲线下面积(AUG)为0.949,且各独立危险因素曲线下面积均> 0.6,差异有统计学意义(P <0.01),预测敏感性为98.4%,特异性为51.5%。结论年龄≥50岁、术前伴灌注不良综合征、全弓置换手术方式(孙氏手术)、术后并发低心排为急性A型主动脉夹层患者术后死亡的独立危险因素。

Objective To analyze risk factors of postoperative hospital death in patients with acute type A aortic dissection and to provide reference for the treatment.Methods Data of 299 patients who underwent surgery in General Hospital of Guangzhou Military Command of PLA between August 2006 and September 2018 were retrospectively analyzed and patients were divided into death group(61 cases)and survival group(238 cases).Perioperative data of the two groups were analyzed and compared.All the independent risk factors were analyzed by multivariate logistic regression.The predictive values of identified risk factors were evaluated by using the area under the receiver operating characteristic(ROC)curve.Results Univariate analysis and logistic regression analysis showed that age≥50,preoperative malperfusion syndrome,total arch replacement(Sun's surgery),complication of low cardiac output were independent risk factors.The area under the curves of joint prediction probability was 0.949,which showed significant differences(P<0.01).The sensitivity of joint prediction probability was 98.4% and the specificity was 51.5% .Conclusion Age≥50,preoperative malperfusion syndrome,total arch replacement(Sun's surgery)and complication of low cardiac output are independent risk factors of postoperative hospital death in patients with acute type A aortic dissection.