急性A型主动脉夹层术后早期临床结果及相关危险因素分析

Early outcomes and related risk factors of acute type A aortic dissection after surgery

目的:探讨急性A型主动脉夹层外科术后早期临床结果及与术后死亡相关的危险因素。方法:回顾性分析2014年5月至2018年5月在我院心血管外科行外科手术治疗的急性A型主动脉夹层患者的临床数据,分析术后患者临床死亡的主要原因,并将患者分成死亡组和存活组,比较两组患者一般资料、术前资料、术中资料、术后7 d内出现的手术相关并发症及术后临床预后等方面的差异,再结合临床进一步行多因素logistic回归分析,探讨与术后死亡相关的独立危险因素。结果:共733例患者入选本研究,其中男性554例,占比75.58%,术后28 d院内死亡72例,术后死亡率为9.82%,术后发生相关并发症主要包括低心排综合征(2.46%)、急性肾损伤(13.23%)、呼吸功能不全(31.24%)以及神经系统并发症(5.87%)。年龄>70岁(OR=1.85,95%CI:0.73~4.70,P<0.01)、输血量>2 000 mL(OR=1.89,95%CI:1.02~3.51,P=0.04)、术后急性肾损伤(OR=7.57,95%CI:4.23~13.58,P<0.01)和术后低心排综合征(OR=3.02,95%CI:1.49~6.15,P<0.01)是引起夹层患者术后死亡的独立危险因素。结论:急性A型主动脉夹层术后早期死亡率高,且术后相关并发症发生率高。高龄、大量输血、术后急性肾损伤及术后低心排综合征是急性A型主动脉夹层术后早期死亡的独立危险因素。

Objective: To investigate early clinical outcomes after surgery for patients with type A aortic dissection(AADA) and the risk factors related to postoperative mortality.Methods: The clinical data of patients with AADA who underwent surgical treatment from May 2014 to May 2018 were retrospectively analyzed. The main causes of clinical death were analyzed. The patients were divided into death group and survival group, and the differences in clinical data, preoperative and intraoperative data, surgery-related complications within 7 d after surgery, and postoperative clinical prognosis were compared between the two groups. Multivariate logistic regression analysis was performed to explore independent risk factors associated with postoperative mortality. Results: A total of 733 patients were enrolled in this study, with 554 males(75.58%) and 72 postoperative deaths(9.82%). The incidence of postoperative complications were mainly low cardiac output syndrome(2.46%), acute kidney injury(13.23%), respiratory insufficiency(31.24%), and complications of nervous system(5.87%). The results of multivariate regression analysis showed that patients over 70 years old(OR=1.85, 95%CI: 0.73-4.70, P<0.01),blood transfusion volume > 2 000mL(OR=1.89, 95%CI: 1.02-3.51, P=0.04), postoperative acute kidney injury(OR=7.57, 95%CI: 4.23-13.58, P<0.01) and postoperative low cardiac output syndrome(OR=3.02, 95%CI: 1.49-6.15, P<0.01) were independent risk factors for postoperative death in patients with AADA surgery. Conclusion: The rates of early mortality and postoperative complications of AADA after surgery are relatively high. Advanced age, large blood transfusion volume, postoperative acute kidney injury and postoperative low cardiac output syndrome are the independent risk factors of early postoperative death of AADA.