急性Stanford A型主动脉夹层患者术后机械通气时间延长的影响因素分析

Influencing Factors of Prolonged Postoperative Mechanical Ventilation Time in Patients with Acute Stanford Type A Aortic Dissection

目的探讨急性Stanford A型主动脉夹层患者术后机械通气时间延长的影响因素。方法回顾性选取2020—2021年郑州大学附属胸科医院收治的急性Stanford A型主动脉夹层患者434例。收集患者的临床资料,根据术后机械通气时间将患者分为延长组189例(术后机械通气时间≥48 h),未延长组245例。采用多因素Logistic回归分析探讨急性Stanford A型主动脉夹层患者术后机械通气时间延长的影响因素。结果延长组年龄大于未延长组,BMI、有高血压史者占比、白细胞计数、血肌酐、出血量、红细胞输注量、血浆输注量、低氧血症发生率、乳酸高于未延长组,凝血酶原时间、手术时间、主动脉阻断时间、体外循环时间、ICU住院时间长于未延长组,肌钙蛋白I低于未延长组(P<0.05)。多因素Logistic回归分析结果显示,年龄[OR=1.024,95%CI(1.007~1.040)]、白细胞计数[OR=1.103,95%CI(1.050~1.157)]、手术时间[OR=1.006,95%CI(1.002~1.010)]、主动脉阻断时间[OR=1.010,95%CI(1.004~1.015)]、乳酸[OR=1.138,95%CI(1.045~1.239)]是急性Stanford A型主动脉夹层患者术后机械通气时间延长的独立影响因素(P<0.05)。结论年龄、白细胞计数、手术时间、主动脉阻断时间、乳酸是急性StanfordA型主动脉夹层患者术后机械通气时间延长的独立影响因素。

Objective To investigate the influencing factors of prolonged postoperative mechanical ventilation time in patients with acute Stanford type A aortic dissection.Methods A total of 434 patients with acute Stanford type A aortic dissection admitted to Chest Hospital of Zhengzhou University from 2020 to 2021 were retrospectively selected.The general data of the patients were collected.The patients were divided into extended group(189 cases)(postoperative mechanical ventilation time≥48 h)and non-extended group(245 cases)according to the postoperative mechanical ventilation time.Multivariate Logistic regression analysis was used to explore the influencing factors of prolonged postoperative mechanical ventilation time in patients with acute Stanford type A aortic dissection.Results The age in extended group was older than that in non-extended group,the BMI,proportion of patients with hypertension history,white blood cell count,serum creatinine,blood loss,red blood cell transfusion volume,plasma transfusion volume,occurrence rate of hypoxemia,and lactate were higher than those in non-prolonged group,the prothrombin time,operation time,aortic cross-clamping time,extracorporeal circulation time,and ICU hospitalization time were longer than those in non-extended group,the troponin I was lower than that in non-extended group(P<0.05).Multivariate Logistic regression analysis showed that age[OR=1.024,95%CI(1.007-1.040)],white blood cell count[OR=1.103,95%CI(1.050-1.157)],operation time[OR=1.006,95%CI(1.002-1.010)],aortic cross-clamping time[OR=1.010,95%CI(1.004-1.015)],lactate[OR=1.138,95%CI(1.045-1.239)]were independent influencing factors of prolonged postoperative mechanical ventilation time in patients with acute Stanford type A aortic dissection(P<0.05).Conclusion Age,white blood cell count,operation time,aortic cross-clamping time,lactate are independent influencing factors of prolonged postoperative mechanical ventilation time in patients with acute Stanford type A aortic dissection.