急性A型主动脉夹层行根部修复手术的早期死亡危险因素分析和护理体会

Analysis of early death risk factors and nursing experience of acute type A aortic dissection undergoing root repair surgery

目的分析急性Stanford A型主动脉夹层患者术后早期死亡危险因素及早期护理需要注意的要点。方法回顾性分析2018年12月至2022年6月期间在空军军医大学第一附属医院行主动脉根部修复手术的281例急性A型主动脉夹层患者。以一般资料、实验室检查指标及影像学指标作为自变量,以患者住院期间/术后30天是否生存作为因变量分为生存组(n=251)和死亡组(n=30),进行单因素分析和多因素logistic回归分析。结果本研究共纳入281例患者,住院期间/术后30天的死亡率为10.7%,通过生存组与死亡组的两组间单因素分析比较发现年龄、既往脑血管意外、既往心源性休克、术前单核细胞数、凝血酶原时间、天冬氨酸转氨酶、丙氨酸转氨酶、D二聚体、脑灌注不良和肾灌注不良的差异具有统计学意义(P<0.05)。多因素logistic回归分析提示,术前脑血管意外、单核细胞数、D-二聚体和脑灌注不良是住院期间/术后30天死亡的独立危险因素。结论关注住院期间/术后30 d死亡的独立危险因素,针对危险因素医护需共同协作积极预防、早期诊疗和护理。

Objective To analyze the risk factors of early postoperative death in patients with acute Stanford type A aortic dissection(ATAAD)and the key points of early nursing care.Methods A retrospective analysis was performed on 281 patients with ATAAD who underwent aortic root repair surgery at the First Affiliated Hospital of Air Force Military Medical University between December 2018 and June 2022.Baseline data,laboratory examination indicators and imaging indicators were used as independent variables,survival during in-hospital/postoperative 30-day was used as dependent variable to divide the patients into survival group(n=251)and death group(n=30).Univariate analysis and multivariate logistic regression analysis were performed.Results A total of 281 patients were enrolled in this study,and in-hospital/postoperative 30-day mortality rate was 10.7%.Univariate analysis showed that there were significant differences in age,previous cerebrovascular accident,previous cardiogenic shock,preoperative monocyte count,preoperative prothrombin time,aspartate aminotransferase,alanine aminotransferase,D-dimer,cerebral malperfusion and renal malperfusion between the survival group and the death group(P<0.05).Multivariate logistic regression analysis showed that preoperative cerebrovascular accident,preoperative monocyte count,preoperative D-dimer and preoperative cerebral malperfusion were independent risk factors for in-hospital/postoperative 30-day mortality.Conclusion Doctors and nurses should focus on the independent risk factors for in-hospital/postoperative 30-day mortality,and cooperate to actively prevent,early diagnosis and care for these risk factors.