术前血清肌酐水平对急性Stanford A型主动脉夹层手术患者短期预后的影响

Effect of preoperative serum creatinine level on short-term prognosis in patients undergoing surgery for acute Stanford type A aortic dissection

目的分析急性Stanford A型主动脉夹层手术患者的术前血清肌酐水平对术后短期预后的影响,为尽早预防和改善预后提供参考。方法收集2018年12月至2021年12月武汉市第三医院胸外科收治的76例急性Stanford A型主动脉夹层患者临床资料。根据术前的血清肌酐水平是否超过133μmol/L将患者分为肌酐高水平组和肌酐低水平组,通过独立样本t检验和χ2检验比较两组患者术后短期并发症发生率和死亡率,同时采用logistic回归分析筛选术后院内死亡的危险因素。结果术前肌酐高水平组术后30 d内死亡率[17.14%(6/35)比2.44%(1/41),χ^(2)=4.882,P<0.05]、术后急性肾损伤[51.43%(18/35)比26.83%(11/41),χ^(2)=2.207,P<0.05]、连续性肾脏替代治疗(CRRT)[22.86%(8/35)比4.88%(2/41),χ^(2)=4.203,P<0.05]、术后急性肺损伤[42.86%(15/35)比19.51%(8/41),χ^(2)=4.203,P<0.05]和术后急性肝损伤[31.43%(11/35)比12.20%(5/41),χ^(2)=4.842,P<0.05]的发生率均高于术前肌酐低水平组患者。Logistic回归结果显示术前血清肌酐高水平是患者术后死亡的独立危险因素[比值比(OR)=1.062,95%可信区间(CI):1.029~1.096,P<0.05]。结论急性Stanford A型主动脉夹层手术患者的术前血清肌酐水平升高会导致术后并发症增多和死亡率上升,短期预后不佳。

ObjectiveTo investigate the effect of preoperative serum creatinine levels on the short-term prognosis of patients undergoing surgery for acute Stanford type A aortic dissection,providing clinical reference for early prevention and improvement of prognosis.MethodsThe clinical data of 76 patients with confirmed diagnosis of acute Stanford type A aortic dissection admitted in the Department of Cardiothoracic Surgery,Wuhan Third Hospital from December 2018 to December 2021 were retrospectively analyzed.Patients were divided into high creatinine level group and low creatinine level group according to preoperative serum creatinine level.The incidence of short-term postoperative complications and mortality of patients in the two groups were compared by independent-samples t-test and χ^(2) test,and the relative risk factors of death were screened by logistic regression analysis.ResultsThe incidence of mortality within 30 days postoperatively[17.14%(6/35)vs.2.44%(1/41),χ^(2)=4.882,P<0.05],postoperative acute kidney injury[51.43%(18/35)vs.26.83%(11/41),χ^(2)=2.207,P<0.05],continuous renal replacement therapy(CRRT)[22.86%(8/35)vs.4.88%(2/41),χ^(2)=4.203,P<0.05],postoperative acute lung injury[42.86%(15/35)vs.19.51%(8/41),χ^(2)=4.203,P<0.05]and postoperative acute liver injury[31.43%(11/35)vs.12.20%(5/41),χ^(2)=4.842,P<0.05]in the preoperative high creatinine group were significantly higher than in the preoperative low creatinine group.The result of logistic regression analysis suggested that preoperative high serum creatinine level was an independent risk factor for postoperative mortality[odds ratio(OR)=1.062,95%confidence interval(CI):1.029-1.096,P<0.05].ConclusionElevated preoperative serum creatinine level in patients undergoing surgery for acute Stanford type A aortic dissection led to increased postoperative complications and increased mortality with a poor short-term prognosis.