A型主动脉夹层术后并发消化道出血的危险因素分析

Risk factors of gastrointestinal bleeding after type A aortic dissection

目的分析A型主动脉夹层(TAAD)患者行孙氏手术后并发消化道出血的危险因素。方法回顾性分析2021年3月至2022年6月于我院接受TAAD孙氏手术的87例患者的临床资料,根据术后是否并发消化道出血将患者分成出血组和未出血组。比较分析2组患者的临床资料;采用二元Logistic回归分析影响消化道出血的危险因素;通过受试者工作特征(ROC)曲线分析术后消化道出血的临床预测因子。结果本研究中,术后并发消化道出血40例(出血组),未出血47例(未出血组)。与未出血组比较,出血组患者起病时间更短,有高血压史的比例更高,术前肌酐异常率更高,术中失血量更多,术后机械通气时间更长,术后感染率更高,预后不良率显著升高,差异均有统计学意义(P<0.05)。2组患者性别、年龄、消化道疾病史、吸烟史、术前血小板、术前国际标准化比值(INR)、术前谷丙转氨酶(ALT)、术前谷草转氨酶(AST)、术前γ-谷氨酰转肽酶(GGT)、术前夹层累及腹主动脉、手术时间、术中体外循环时间、术中停循环时间、术中主动脉阻断时间、术中输血率比较差异均无统计学意义(P>0.05)。Logistic回归分析显示,高血压史(OR=2.468,95%CI:0.862~7.067,P=0.037)、术前肌酐>105μmol/L(OR=3.970,95%CI:1.352~11.659,P=0.011)、术后机械通气时间较长(OR=1.015,95%CI:0.094~1.018,P=0.041)、术后感染(OR=3.435,95%CI:0.991~11.900,P=0.012)是TAAD患者术后并发消化道出血的独立危险因素。ROC曲线显示,术后机械通气时间超过64 h是TAAD患者术后并发消化道出血的临床预测因子。结论孙氏手术后并发消化道出血的TAAD患者预后较差,高血压史、术前急性肾功能不全、术后机械通气时间较长、术后感染与TAAD患者术后并发消化道出血密切相关,应给予高度重视,做好相应的评估、早期识别、早期干预,以提高患者预后。

Objective To analyze the risk factors of gastrointestinal bleeding in patients with type A aortic dissection(TAAD)after Sun´s operation.Methods The clinical data of 87 patients who underwent TAAD Sun´s operation in our hospital from March 2021 to June 2022 were retrospectively analyzed.They were divided into the bleeding group and the non-bleeding group according to whether there was gastrointestinal bleeding after operation.The clinical data of patients in the two groups was compared and analyzed.The binary Logistic regression analysis was used to analyze the risk factors of gastrointestinal bleeding.The clinical predictor of postoperative gastrointestinal bleeding was analyzed by receiver operating characteristic(ROC)curve.Results In this study,there were 40 cases of postoperative gastrointestinal bleeding(the bleeding group)and 47 cases of non-bleeding(the non-bleeding group).Compared with the non-bleeding group,the bleeding group had a shorter onset time,a higher proportion of patients with hypertension history,a higher preoperative creatinine abnormality rate,more intraoperative blood loss,longer postoperative mechanical ventilation time,higher postoperative infection rate,and higher poor prognosis rate,with statistically significant differences(P<0.05).There was no statistically significant difference in the gender,age,gastrointestinal diseases history,smoking history,preoperative platelets,preoperative international normalized ratio(INR),preoperative alanine aminotransferase(ALT),preoperative aspartate aminotransferase(AST),preoperativeγ-glutamyl transpeptidase(GGT),preoperative dissection involving abdominal aorta,operation time,intraoperative cardiopulmonary bypass time,intraoperative circulatory arrest time,intraoperative aortic occlusion time or intraoperative blood transfusion rate.Logistic regression analysis showed that hypertension history(OR=2.468,95%CI:0.862 to 7.067,P=0.037),preoperative creatinine>105μmol/L(OR=3.970,95%CI:1.352 to 11.659,P=0.011),long postoperative mechanical ventilation time(OR=1.015,95%CI:0.094 to 1.018,P=0.041)and postoperative infection(OR=3.435,95%CI:0.991 to 11.900,P=0.012)were the independent risk factors for postoperative gastrointestinal bleeding in TAAD patients.ROC curve showed that the postoperative mechanical ventilation time exceeding 64 hours were the clinical predictor of postoperative gastrointestinal bleeding in TAAD patients.Conclusion The prognosis of TAAD patients with postoperative gastrointestinal bleeding after Sun´s operation is poor.Hypertension history,preoperative acute renal insufficiency,long postoperative mechanical ventilation time and postoperative infection are closely related to postoperative gastrointestinal bleeding in TAAD patients after operation,which should be paid more attention to,and corresponding evaluation,early identification and early intervention should be made to improve the prognosis of patients.