Stanford A型主动脉夹层术后早期发生脑血管事件相关危险因素分析

Risk factors associated with early cerebrovascular accident after Stanford A aortic dissection

目的:分析Stanford A型术后早期并发脑血管事件相关危险因素。方法:回顾性分析2012年1月至2019年3月,在我院诊治的Stanford A型主动脉夹层患者116例,术后发生脑血管事件患者15例,包括缺血性脑卒中11例,出血性脑卒中患者4例,未发生脑血管事件患者101例。收集患者一般资料(年龄、性别、合并症)、术中各项手术指标(手术时间、停循环事件、转机时间、阻断时间等)、术后发生低心排、心房颤动等,危险因素,并利用Logistic进行多因素分析。结果:单因素分析显示:LVEF<30%、心房颤动、颈动脉病变、停循环时间、术后低心排、术后凝血功能异常与患者术后发生脑血管事件有关,使用Logistic回归分析发现,停循环时间(OR=3.021,P=0.012)、术后低心排(OR=2.812,P=0.000)是影响患者术后早期发生脑血管事件的危险因素。结论:Stanford A型主动脉夹层手术总体效果令人满意。术后低心排、停循环时间是影响术后早期脑血管事件发生的危险因素。

Objective:To analyze the risk factors associated with early cerebrovascular accident after Stanford A operation.Methods:116 patients with Stanford A aortic dissection treated in our hospital from January 2012 to March 2019 were retrospectively analyzed.Fifteen patients with cerebrovascular accident occurred after operation,including 11 patients with ischemic stroke,4 patients with hemorrhagic stroke and 101 patients without cerebrovascular accident.General data of patients(age,sex,complications),intraoperative operative operative indicators(operation time,circulatory arrest events,turn-around time,interruption time),low cardiac output and atrial fibrillation after operation were collected.Risk factors were analyzed by single factor chi-square test or t-test,and multiple factors were analyzed by Logistic.Results:Univariate analysis showed that LVEF<30%,atrial fibrillation,carotid artery disease,circulatory arrest time,low cardiac output and abnormal coagulation function were associated with cerebrovascular accident.Logistic regression analysis showed that circulatory arrest time(P=0.012,OR=3.021),low cardiac output(P=0.000,OR=2.812)were independent risk factors affecting the early occurrence of cerebrovascular accident.Factor.Conclusions:The overall effect of Stanford A aortic dissection is satisfactory.Postoperative low cardiac output and circulatory arrest time are independent risk factors for early cerebrovascular accident.