375例急性Stanford A型主动脉夹层手术后延迟拔管相关因素的回顾性分析

Retrospective analysis related factors of postoperative delayed tracheal extubation in patient with 375 acute Stanford type A aortic dissection

目的:探究急性A型主动脉夹层(AAD)术后延迟拔管的危险因素,为该并发症的早期防治提供相关依据。方法:回顾性分析于首都医科大学附属北京安贞医院2015年9月至2021年4月期间,收治的375例AAD患者,分为非延迟拔管组(术后拔管时间≤24 h)和延迟拔管组(术后拔管时间>24 h),分析两组患者围术期指标,归纳并总结术后延迟拔管的相关危险因素。结果:AAD患者术后延迟拔管的发生率为35.2%(132/375)。Logistic多元素回归分析显示,年龄(OR=1.030,95%CI:1.007~1.053,P=0.011)、自体血小板分离(OR=0.198,95%CI:0.114~0.345,P=0.000)、术中红细胞应用(OR 1.854,95%CI:1.094~3.141,P=0.022)、手术时间(OR=1.481,95%CI:1.220~1.798,P=0.000)、术后血制品应用(冰冻血浆:OR=1.001,95%CI:1.001~1.002,P=0.001;血小板OR=1.365,95%CI:1.077~1.732,P=0.010)是术后延迟拔管的危险因素。结论:高龄、未实施血小板分离、术中输入红细胞、长时间手术、术后输入冰冻血浆和血小板是AAD患者术后延迟拔管的危险因素。早期识别这些危险因素,有助于减少术后延迟拔管的发生率,改善患者预后。

Objective:To explore the related factors of postoperative delayed tracheal extubation for acute stanford type A aortic dissection(AAD)and to provide relevant evidence for the early prevention and treatment of this complication.Methods:A retrospective analysis in Capital Medical University Affiliated Beijing Anzhen hospital from Semtember 2015 to April 2021.The patients were divided into delayed tracheal extubation group(n=132)and normal tracheal extubation group(n=243).The clinical data was compared and the risk factors of postoperative delayed tracheal extubation for patients with AAD were analyzed.Results:The incidence of delayed tracheal extubation of AAD was 35.2%(132/375).Logistic multi-element regression analysis show that age(OR=1.030,95%CI:1.007-1.053,P=0.011),autologous plateletpheresis(OR=0.198,95%CI:0.114-0.345,P=0.000),intraoperative blood transfusion(OR=1.854,95%CI:1.094~3.141,P=0.022),duration of operation(OR=1.481,95%CI:1.220-1.798,P=0.000),postoperative blood product use(frozen plasma:OR=1.001,95%CI:1.001-1.002,P=0.001;platelets:OR=1.365,95%CI:1.077-1.732,P=0.010).Conclusions:Older age,non-autologous plateletpheresis,intraoperative blood transfusion,prolonged surgery time,postoperative frozen plasma and platelet use were independent predictors of delayed tracheal extubation retrospective.Early identification of these risk factors is helpful to reduce the incidence of delayed extubation and improve the prognosis of patients.