急性A型主动脉夹层术后高胆红素血症的危险因素分析

Risk factors for postoperative hyperbilirubinemia in patients with acute type A aortic dissection

目的 研究急性A型主动脉夹层(acute type A aortic dissection, ATAAD)术后发生高胆红素血症的危险因素及其对预后的影响。方法 收集河南省胸科医院2021年1月至2021年10月181例ATAAD患者的手术资料,根据术后血胆红素峰值≥34.2μmmol/L分为高胆红素组(n=45例)和对照组(n=136例)。记录并比较两组患者人口学特征、术前及术后等相关变量,并采用logistic回归分析ATAAD围术期发生高胆红素血症的独立危险因素。同时,对两组患者的最低氧合指数、最高肌酐、最高谷丙转氨酶、ICU滞留天数及病死率进行预后分析。结果 两组患者资料进行多因素分析发现术前TBIL(OR=1.112,95%CI:1.036~1.194,P=0.003)、体外循环(cardiopulrnonary bypass, CPB)时间(OR=1.105,95%CI:1.059~1.152,P<0.001)、术中出血(OR=0.997,95%CI:0.994~1.000,P=0.034)、术中输注红细胞(OR=2.170,95%CI:1.266~3.717,P=0.005)是ATAAD术后高胆红素血症的独立危险因素,其曲线下面积分别为0.671、0.750、0.598和0.667。两组患者的最低氧合指数、最高肌酐、最高谷丙转氨酶、ICU滞留天数及病死率之间的比较,差异均有统计学意义(P<0.05)。结论 术前TBIL、CPB时间、术中出血量、术中输注红细胞是ATAAD术后发生高胆红素血症的独立危险因素。ATAAD术后高胆红素血症的发生率较高,预后较差。因此应重视围手术期高胆红素血症的相关危险因素,动态监测血清总胆红素变化,积极地寻找病因和诊治,以期能够改善患者预后。

Objective To investigate the risk factors for postoperative hyperbilirubinemia after acute type A aortic dissection(ATAAD) and their prognostic aortic dissection.Methods The surgical data of 181 ATAAD patients in Henan Chest Hospital from January 2021 to October 2021 were collected. The patients were divided into hyperbilirubinemia group(n= 45) and control group(n= 136) according to the peak value of serum bilirubin ≥34.2 mol/L.Demographic characteristics, preoperative and postoperative variables were recorded and compared between the two groups. The independent risk factors of hyperbilirubinemia during ATAAD were analyzed by logistic regression.The lowest Oxygenation Index, the highest creatinine, the highest Alanine transaminase, the days of ICU stay and the mortality were analyzed.Results Multivariate analysis showed that preoperative TBIL(OR=1.112,95%CI: 1.036-1.194, P=0.003), duration of cardiopulmonary bypass(CPB)(OR=1.105,95%CI: 1.059-1.152, P<0.001), intraoperative bleeding(OR=0.997,95%CI: 0.994-1.000, P=0.034) and intraoperative red blood cell infusion(OR=2.170.95%CI: 1.266-3.717, P=0.005) were independent risk factors for postoperative hyperbilirubinemia after ATAAD, the area under the curve was 0.671,0.750,0.598 and 0.667 respectively.There were significant differences in the lowest oxygenation index, the highest creatinine, the highest Alanine transaminase index, the length of stay in ICU and the mortality between the two groups(P<0.05).Conclusion Preoperative TBIL, CPB duration, intraoperative blood loss, and intraoperative red blood cell infusion are independent risk factors for postoperative hyperbilirubinemia after ATAAD.The incidence of hyperbilirubinemia after ATAAD is high and the prognosis is poor. Therefore, we should pay attention to the risk factors of perioperative hyperbilirubinemia, dynamically monitor the changes of serum total bilirubin, actively search for the causes and diagnosis and treatment, in order to improve the prognosis of patients.