阻塞性睡眠呼吸暂停低通气综合征对Stanford A型主动脉夹层围手术期及三年全因死亡率的影响

The impact of obstructive sleep apnea hypopnea syndrome on the perioperative and long-term outcome in patients with Stanford type A aortic dissection

目的探讨阻塞性睡眠呼吸暂停低通气综合征(OSAHS)对Stanford A型主动脉夹层围手术期及3年全因死亡率的影响。方法前瞻性纳入2010年6月至2017年7月于青岛市市立医院心脏病中心接受手术治疗的Stanford A型主动脉夹层患者91例,其中男性67例,女性24例,年龄44~69(56.4±12.8)岁。91例患者中,合并OSAHS的患者51例,被纳入研究组,不伴OSAHS的患者40例,被纳入对照组。随访观察36个月,将全因死亡作为终点事件。采用卡方检验对比分析两组术前及术中的临床基线资料,以Kanplan-Meier法描述两组术后36个月的生存曲线,应用Cox比例风险模型评估术后36个月生存率的风险比(HR)及其95%可信区间(CI)。结果患者住院期间死亡率在研究组为5.9%(3例),对照组为5.0%(2例),差异无统计学意义(χ^(2)=0.03,P>0.05)。实际随访(36.2±1.5)个月,88例完成随访,3例失随访。36个月全因死亡率在研究组为27.5%(14/51),对照组为10.0%(4/40),差异有统计学意义(χ^(2)=4.30,P<0.05)。经Cox比例风险模型分析,在调整年龄、男性、主动脉瓣二叶化畸形、慢性阻塞性肺疾病、贫血、术前心包填塞、术后脏器功能不全、术前左室射血分数、急诊手术、孙氏手术、冠状动脉旁路移植、高血压、心律失常、主动脉远端夹层进展撕裂后,与对照组相比,研究组的术后36个月生存率更低(P<0.05)。除OSAHS之外,冠状动脉旁路移植、术前心包填塞也是36个月死亡率升高的危险因素(HR=11.28,95%CI为2.18~46.25,P<0.01;HR=9.08,95%CI为2.22~41.3,P<0.05)。结论合并OSAHS的Stanford A型主动脉夹层患者,术后住院期间死亡率无明显差异,术后36个月生存率较对照组降低。

Objective To confirm the impact of obstructive sleep apnea hypopnea syndrome(OSAHS)on perioperative and long-term outcome in patients with Stanford type A aortic dissection.Methods From June 2010 to July 2017,the clinical data of 91 patients with Stanford type A aortic dissection were analyzed.Among them,51 patients with OSAHS were included in the study group and 40 patients without OSAHS were included in the control group.After 36 months follow-up,all-cause death was regarded as the end event.The clinical baseline data,perioperative period and 36 months survival rate of the two groups were compared.Kanplan-Meier method was used to describe the 36 month survival curve of the two groups.Cox proportional risk model was used to evaluate the risk ratio(HR)and 95%CI of 36 month survival rate.Results The mortality rate during hospitalization was 5.9%(3 cases)in the study group and 5.0%(2 cases)in the control group,and the difference was not statistically significant(χ^(2)=0.03,P>0.05).The actual follow-up was(36.2±1.5)months,88 cases were followed up and 3 cases were lost.The all cause mortality rate of 36 months was 27.5%(14/51)in the study group and 10.0%(4/40)in the control group,the difference was statistically significant(χ^(2)=4.30,P<0.05).By Cox proportional risk model analysis,36 months after operation,the study group was compared with the control group after adjusting for age,male,bicuspid of aortic valve,chronic obstructive pulmonary disease,anemia,preoperative pericardial tamponade,postoperative organ dysfunction,preoperative LVEF,emergency operation,Sun′s operation,coronary artery bypass grafting,hypertension,cardiac arrhythmia,and advanced avulsion of distal aortic dissection The survival rate was lower,the difference was statistically significant(P<0.05).In addition to OSAHS,coronary artery bypass grafting and preoperative pericardial tamponade were also risk factors for the increase of 36 month mortality rate(HR=11.28,95%CI:1.98-46.25,P=0.009;HR=9.08,95%CI:2.22-41.3,P=0.032).Conclusions There was no significant difference in mortality during hospitalization in patients with Stanford A aortic dissection combined with OSAHS.The survival rate of 36 months after operation was lower than that of the control group.