急性A型主动脉夹层患者行孙氏手术后呼吸衰竭的发生情况及其危险因素和治疗策略

Incidence,risk factors and treatment strategies of respiratory failure after Sun′s surgery in patients with acute type A aortic dissection

目的探讨行孙氏手术急性A型主动脉夹层(ATAAD)患者术后呼吸衰竭发生情况、危险因素与相应措施。方法收集首都医科大学附属北京安贞医院2017年1月至2019年8月收治的726例ATAAD患者的基本临床资料进行回顾性分析,手术术式均为孙氏手术,且均在中低温停循环条件下进行。根据术后是否发生呼吸衰竭分为无呼吸衰竭组(609例)和呼吸衰竭组(117例)。分别统计2017、2018、2019年孙氏手术术后呼吸衰竭发生率。比较无呼吸衰竭组和呼吸衰竭组的基本资料。分析呼吸衰竭的危险因素。结果726例患者总呼吸衰竭发生率为16.1%。2017、2018、2019年呼吸衰竭发生率分别为24.6%(59/240)、14.2%(36/254)、9.5%(22/232),逐年降低,差异有统计学意义(χ^(2)=20.989,P<0.001);与实施复合性肺保护措施有关。多因素Logistic回归分析发现,女性、年龄、发病时间、天冬氨酸转氨酶水平以及体外循环时间为呼吸衰竭的独立危险因素(比值比=2.101、1.043、0.989、1.006、1.006,均P<0.05)。结论女性、年龄、发病时间、天冬氨酸转氨酶水平以及体外循环时间为ATAAD患者孙氏手术后呼吸衰竭的独立风险因素。围术期综合肺保护策略的实施能够有效降低呼吸衰竭发生率。

Objective To discuss the incidence,risk factors and treatment strategies of respiratory failure after Sun′s surgery in patients with acute type A aortic dissection(ATAAD).Methods The basic clinical data of 726 patients with ATAAD admitted to Beijing Anzhen Hospital,Capital Medical University from January 2017 to August 2019 were retrospectively analyzed.All patients underwent Sun′s surgery under the condition of moderate and low temperature circulatory arrest.According to whether respiratory failure occurred after operation,they were divided into non respiratory failure group(609 cases)and respiratory failure group(117 cases).The incidences of respiratory failure after Sun′s surgery in 2017,2018 and 2019 were counted respectively.The basic data of non respiratory failure group and respiratory failure group were compared.The risk factors of respiratory failure were analyzed.Results The total incidence of respiratory failure in 726 patients was 16.1%,and the incidences in 2017,2018 and 2019 were 24.6%(59/240),14.2%(36/254)and 9.5%(22/232)respectively,showing a significant downward trend(χ^(2)=20.989,P<0.001).It was related to the implementation of compound lung protection measures.Multivariate Logistic regression analysis showed that female,age,onset time,aspartate aminotransferase level and cardiopulmonary bypass time were independent risk factors of respiratory failure(odds ratio=2.101,1.043,0.989,1.006,1.006,all P<0.05).Conclusions Female,age,onset time,aspartate aminotransferase level and cardiopulmonary bypass time are independent risk factors for postoperative respiratory failure in patients with ATAAD after Sun′s surgery.The implementation of perioperative comprehensive lung protection can effectively reduce the incidence of respiratory failure.