术前心率对急性B型主动脉夹层患者围术期发生主动脉相关不良事件的影响

Effect of preoperative heart rate on perioperative aorta-related adverse events in patients with acute type B aortic dissection

目的探讨术前心率对急性B型主动脉夹层(ATBAD)患者围术期发生主动脉相关不良事件(ARAE)的影响。方法回顾性分析安徽医科大学第一附属医院2017年1月至2019年6月232例ATBAD患者的临床资料。用受试者工作特征曲线(ROC曲线)分析得出术前心率预测ATBAD患者发生ARAE的最佳诊断值,根据该值将患者分为两组,采用倾向得分匹配法控制混杂因素,比较两组之间的差异。结果ATBAD患者围术期发生ARAE的独立危险因素有女性(P=0.035)、年龄(P=0.017)、高血压(P=0.002)、动脉粥样硬化(P=0.045)、复杂型夹层(P<0.001)、术前心率(P=0.006)以及舒张压水平(P=0.027)。根据术前心率预测ATBAD患者发生ARAE的最佳诊断值为87次/min,将患者分为两组,A组(n=159,心率<87次/min)和B组(n=73,心率≥87次/min)。经过倾向性匹配后,共有66对数据匹配良好,分别为A'组和B'组,术前心率分别为(73±9)次/min和(100±14)次/min(t=-13.248,P<0.001)。总ARAE发生率为21.2%(28/132),B'组ARAE发生率显著高于A'组,分别为30.3%和12.1%(χ2=6.527,P=0.011)。而A'、B'两组间主动脉夹层破裂的风险差异无统计学意义(χ2=2.129,P=0.274)。结论术前心率是ATBAD患者围术期发生ARAE的独立危险因素之一,心率≥87次/min时,围术期ARAE发生率明显升高。

Objective To investigate the effect of preoperative heart rate on the occurrence of aorta-related adverse events(ARAE)in patients with acute type B aortic dissection(ATBAD)during perioperative period.Methods The clinical data of 232 patients with acute type B aortic dissection from January 2017 to June 2019 in the First Affiliated Hospital of Anhui Medical University were analyzed retrospectively.ROC curve analysis was used to obtain the optimal diagnostic value of preoperative heart rate for predicting ARAE in ATBAD patients.Patients were divided into two groups.Differences between the two groups were compared,using propensity score matching(PSM)to control for confounding factors.Results The independent risk factors for ARAE in ATBAD patients were female gender(P=0.035),age(P=0.017),hypertension(P=0.002),atherosclerosis(P=0.045),complicated dissection(P<0.001),preoperative heart rate(P=0.006)and diastolic blood pressure level(P=0.027).Patients with ATBAD were divided into two groups according to the optimal diagnosis of ARAE predicted by preoperative heart rate:group A(n=159,P<87 beats/min)and group B(n=73,P≥87 beats/min).After propensity matching,a total of 66 pairs of data were well matched,which were in the A',B'group,respectively,and the preoperative heart rates were(73±9)beats/min and(100±14)beats/min,respectively(t=-13.248,P<0.001).The incidence of total ARAEs was 21.2%(28/132),and the incidence of ARAEs in the B'group was significantly higher than that in the A'group,30.3%and 12.1%,respectively(χ2=6.527,P=0.011).However,there was no significant difference in the risk of aortic dissection rupture between the two groups of A'and B'(χ2=2.129,P=0.274).Conclusion Preoperative heart rate is one of the independent risk factors for perioperative aorta-related adverse events in patients with ATBAD,and the incidence of perioperative ARAE is significantly increasing when the heart rates are≥87 beats/min.