Standford A型主动脉夹层术后早期死亡危险因素分析

Factors related to early postoperative mortality in patients with Stanford type A aortic dissection

目的:分析Stanford A型主动脉夹层患者术后早期死亡的危险因素。方法:回顾性分析2015年9月至2020年12月在上海市第一人民医院心脏大血管外科行外科手术的119例Stanford A型主动脉夹层患者的临床资料。根据患者术后30 d预后情况将患者分为死亡组(n=17)与存活组(n=102),收集2组患者的临床病例资料,进行单因素分析和多因素logistic回归分析。结果:单因素分析发现术前合并心肌梗死、术前肝功能不全、术前肾功能不全、体外循环时间、手术时间、术后血红蛋白最低值、术后脊髓损伤、术后心包积液是Stanford A型主动脉夹层患者术后30 d死亡的危险因素(P均<0.05)。多因素logistic回归分析显示,术前合并心肌梗死(95%CI:0.005~0.334,P=0.003)、术前肾功能不全(95%CI:0.047~0.923,P=0.039)和术后脊髓损伤(95%CI:0.008~0.741,P=0.026)是患者术后30 d死亡的独立危险因素。结论:术前合并心肌梗死、术前肾功能不全和术后脊髓损伤是Stanford A型主动脉夹层患者行外科手术后早期死亡的独立危险因素。

Objective: To analyze the risk factors of early postoperative mortality in patients with Stanford type A aortic dissection. Methods: Clinical data of 119 patients with Stanford type A aortic dissection who underwent surgery at Shanghai General Hospital from September 2015 to December 2020, were retrospectively analyzed. Patients were divided into death group(n=17) and survival group(n=102) based on outcomes at 30 days after surgery.Perioperative indexes and early postoperative risk factors for death were collected. Results:Univariate analysis showed that preoprerative aortic dissection combined with myocardial infarction, preoperative liver dysfunction, preoperative renal dysfunction, cardiopulmonary bypass time, duration of operation, the lowest hemoglobin count, spinal cord injury and pericardial effusion were significantly associated with early mortality(all P<0.05). Multivariable analysis revealed that aortic dissection combined with myocardial infarction(95%CI: 0.005~0.334,P=0.003), preoperative renal dysfunction(95%CI: 0.047~0.923, P=0.039) and spinal cord injury(95%CI: 0.008~0.741, P=0.026) were independent risk factors for 30-day mortality. Conclusion: Aortic dissection combined with myocardial infarction, preoperative renal dysfunction and spinal cord injury are critical factors related to early postoperative mortality in patients with Stanford type A aortic dissection.