Stanford A型主动脉夹层患者术后消化道出血的临床分析

Clinical analysis of postoperative gastrointestinal hemorrhage in patients with Stanford A aortic dissection

目的:测探讨Stanford A型主动脉夹层患者术后消化道出血的临床因素及治疗。方法:回顾分析我中心自2018年1月至2021年6月,Stanford A型主动脉夹层患者术后消化道出血的患者12例(男7例,58.3%),平均年龄(60.6±10.4)岁,和同期Stanford A型主动脉夹层患者共249例为对比组(男188例,75.5%),平均年龄(50.0±13.5)岁,全部行开放性主动脉修复术。对患者围术期重要的临床变量进行统计,对差异有统计学意义的单变量纳入多因素Logistic回归模型,对Stanford A型夹层患者术后消化道出血的临床因素进行分析。结果:两组患者的单因素对比中,年龄、术前SPO2<95%、术中停循环时间、术后低心排血量综合征、术后摄氧浓度≥50%、连续肾替代疗法(CRRT)、感染、住院时间、在ICU时间及死亡率方面,差异有统计学意义(P均<0.05)。将有意义的单变量纳入Logistic回归模型,其术前SPO2<95%及术后CRRT为Stanford A型夹层患者术后消化道出血的危险因素。结论:Stanford A型主动脉夹层即使不累及肠系膜上动脉,也会发生严重的消化道出血,部分为非闭塞性肠系膜缺血。对于术后消化道出血患者,术前SPO2<95%及术后CRRT为危险因素;认识其病因,早期识别和积极治疗可能改善预后。

Objective:It is to investigate the clinical factors and treatment of postoperative gastrointestinal bleeding among patients with Stanford type A aortic dissection.Method:Retrospective analysis of cases of postoperative gastrointestinal bleeding in patients with Stanford type A aortic dissection from January 2018 to June 2021 at our center.A total of 12 cases of gastrointestinal bleeding were collected(7 males,58.3%),age(60.6±10.4)years,and 249 cases of Stanford type A aortic dissection in the same period were taken as the control group(188 males,75.5%),age(50.0±13.5)years.All patients underwent open aortic repair.The important clinical variables of patients in the perioperative period were statistically analyzed.Statistically significant univariates were included in the multivariate Logistic regression model to analyze the clinical factors of postoperative gastrointestinal bleeding in Stanford A type dissection patients.Results:In the univariate comparison between the two groups,statistically significant differences were found in age, preoperative SPO2 <95%, intraoperative time to circulatory arrest, postoperative low cardiac output syndrome, postoperative oxygen uptake concentration ≥ 50%, CRRT, infection, length of stay, time in the ICU, and mortality (all P < 0.05). Significant univariate variables were included in a logistic regression model with preoperative SPO2 <95% and postoperative CRRT as independent risk factors for postoperative gastrointestinal bleeding in patients with Stanford type A aortic dissection. Conclusions: Stanford type A aortic dissection is associated with severe gastrointestinal bleeding even if it does not involve the superior mesenteric artery, and some of them are non-occlusive mesenteric ischemia. In patients with postoperative GI bleeding, preoperative SPO2 <95% and postoperative CRRT are independent risk factors;recognition of its etiology, early identification and aggressive treatment may improve the prognosis.