急性A型主动脉夹层术后发生急性呼吸窘迫综合征相关危险因素分析

Independent risk factors related to acute respiratory distress syndrome after acute type A aortic dissection surgery:A retrospective analysis

目的讨论急性A型主动脉夹层术后发生急性呼吸窘迫综合征(acute respiratory distress syndrome,ARDS)的危险因素。方法回顾性分析2015—2019年在安徽医科大学第一附属医院心脏大血管外科行手术治疗147例急性A型主动脉夹层患者的临床资料,其中男110例,平均年龄(51.9±10.1)岁;女37例,平均年龄(54.3±11.1)岁。根据患者术后是否发生ARDS,将所有患者分为ARDS组和非ARDS组。采用单因素及多因素logistic分析建立回归模型,筛选出与ARDS相关的独立危险因素。结果25例(17.0%)患者术后发生ARDS,其中轻度5例(3.4%),中度13例(8.8%),重度7例(4.8%)。多因素logistic回归分析显示,深低温停循环时间[OR=1.067,95%CI(1.014,1.124),P=0.013]、体外循环时间[OR=1.012,95%CI(1.001,1.022),P=0.027]及围手术期血浆输入量[OR=1.001,95%CI(1.000,1.002),P=0.011]与ARDS独立相关。受试者工作特征(receiver operating characteristic,ROC)曲线分析显示回归模型的整体预测能力较好[ROC曲线下面积=0.835,95%CI(0.740,0.929),P=0.000]。结论深低温停循环时间、体外循环时间及围手术期血浆输入量是急性A型主动脉夹层术后发生ARDS的独立危险因素。

Objective To investigate the independent risk factors associated with postoperative acute respiratory distress syndrome in patients undergoing type A aortic dissection surgery.Methods The clinical data of 147 patients who underwent acute type A aortic dissection surgery in the First Affiliated Hospital of Anhui Medical University from2015 to 2019 were retrospectively analyzed.There were 110 males at age of 51.9±10.1 years and 37 females at age of54.3±11.1 years.According to whether the patients developed ARDS after surgery,all of the patients were divided into a ARDS group or a non-ARDS group.Logistic regress analysis was utilized to establish the predictive mode to identify the independent risk factors related to ARDS.Results Of the patients,25 developed postoperative ARDS.Among them,5patients were mild ARDS,13 patients were moderate,and 7 patients were severe ARDS.Multivariate logistic regression analysis showed that deep hypothermic circulatory arrest time[odds ratio(OR)=1.067,95%confidence interval(CI)1.014-1.124,P=0.013],cardiopulmonary bypass time(OR=1.012,95%CI 1.001-1.022,P=0.027)and perioperative plasma input(OR=1.001,95%CI 1.000-1.002,P=0.011)were independently associated with ARDS in patients undergoing acute A aortic dissection surgery.Receiver operating characteristic(ROC)curve analysis demonstrated a good discrimination ability of the logistic regression model,with an area under the curve of 0.835(95%CI 0.740-0.929,P=0.000).Conclusion Duration of deep hypothermic circulatory arrest,cardiopulmonary bypass time and perioperative plasma are independent risk factors for postoperative ARDS in patients undergoing type A aortic dissection surgery.