急性Stanford A型主动脉夹层患者术后早期发生全身炎症反应综合征的危险因素分析及其对预后的影响

Risk factors and influence of early postoperative systemic inflammatory response syndrome on prognosis in patients with acute Stanford type A aortic dissection

目的分析急性Stanford A型主动脉夹层(ATAAD)患者术后早期全身炎症反应综合征(SIRS)对预后的影响及其危险因素。方法回顾性收集2019年1月至2021年1月期间武汉亚洲心脏病医院收治的146例ATAAD患者临床资料,按照术后24 h内是否出现SIRS分为SIRS组(61例)和非SIRS组(85例),比较两组患者的预后情况差异并分析其危险因素。结果SIRS组急性肾损伤11例(18.03%)、肝功能不全17例(27.87%)、谵妄36例(59.02%)、死亡9例(14.75%);非SIRS组急性肾损伤4例(4.71%)、肝功能不全7例(8.24%)、谵妄33例(38.82%)、死亡1例(1.18%);比较两组人数SIRS组均多于非SIRS组(P<0.05)。单因素分析显示,心肺转流时间、术后带管时间、ICU停留时间、机械通气时间、围术期出血量、围术期输血量、白细胞计数(WBC)、急性生理和慢性健康(APACHEⅡ)评分及序贯器官衰竭(SOFA)评分与术后早期发生SIRS显著相关(P<0.05)。多因素logistics回归分析显示,WBC、APACHEⅡ评分、SOFA评分、机械通气时间是ATAAD患者术后早期发生SIRS的独立危险因素。由此构建ATAAD患者术后早期SIRS转归风险预测模型,该模型预测ATAAD患者术后早期SIRS的曲线下面积(AUC)为0.928,95%CI为0.874~0.964,约登指数为0.781,截断值为0.465,敏感度、特异度分别为85.25%和92.94%。结论ATAAD患者术后早期发生SIRS会增加患者急性肾损伤、肝功能不全、谵妄及死亡人数,对SIRS危险因素进行控制可以改善预后。

Objective To explore the risk factors and influence of early postoperative systemic inflammatory response syndrome(SIRS)on prognosis in the patients with acute Stanford type A aortic dissection(ATAAD).Methods The clinical data of 146 patients with ATAAD admitted to the Wuhan Asia Heart Hospital from January 2019 to January 2021 were collected and the patients were divided into the SIRS group(n=61)and non-SIRS group(n=85)according to whether SIRS occurred within 24 h after the surgery.The prognosis of the two groups was compared and the risk factors were analyzed.Results There were 11 cases(18.03%)of acute kidney injury,17 cases(27.87%)of hepatic insufficiency,36 cases(59.02%)of delirium and 9 cases(14.75%)of death in the SIRS group but 4 cases(4.71%)of acute kidney injury,7 cases(8.24%)of hepatic insufficiency,33cases(38.82%)of delirium,and 1 case(1.18%)of death in the non-SIRS group;compared with the non-SIRS group,the number of complication in the SIRS group was more than in the non-SIRS group(P<0.05).Univariate analysis showed that the cardiopulmonary bypass time,postoperative intubation time,ICU stay,mechanical ventilation time,perioperative period blood loss,perioperative period blood transfusion volume,white blood cell count(WBC),score of acute physiology and chronic health evaluationⅡ(APACHEⅡ)and score of sequential organ failure assessment(SOFA)were significantly associated with the development of SIRS in the early postoperative period(P<0.05).Multivariate logistics regression analysis showed that WBC,APACHEⅡscore,SOFA score and mechanical ventilation time were the independent risk factors for early postoperative SIRS in patients with ATAAD.This led to the construction of a predictive model for the risk of early postoperative SIRS regression in ATAAD patients,and the area under the curve(AUC),95%CI,Youden index,cut-off value,sensitivity and specificity of this model in predicting the early postoperative SIRS were 0.928,0.874-0.964,0.781,0.465,85.25%and 92.94%respectively.Conclusion Early postoperative SIRS in the patients with ATAAD would increase the number of acute kidney injury,liver insufficiency,delirium and deaths.Controlling the risk factors of SIRS could improve the prognosis.