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急性Stanford A型主动脉夹层患者术后脊髓损伤的危险因素分析

Analysis of risk factors for postoperative spinal cord injury in patients with acute Stanford type A aortic dissection
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摘要 目的分析急性Stanford A型主动脉夹层患者接受全主动脉弓部人工血管替换(total aortic arch replacement,TAAR)联合冷冻象鼻技术(frozen elephant trunk,FET)治疗后脊髓损伤(spinal cord injury,SCI)的危险因素。方法回顾性收集2017年9月至2023年6月广东省人民医院接受TAAR联合FET治疗的698例急性Stanford A型主动脉夹层患者临床资料,其中48例术后发生SCI的患者设置为SCI组,其余650例患者为非SCI组,使用多因素Logistic回归分析术后SCI的危险因素。结果单因素分析结果显示,两组在糖尿病史、脑血管病史、纤维蛋白原含量、发自假腔肋间动脉数量、第6、9、12胸椎水平真腔面积、体外循环前乳酸水平、主动脉阻断时间、体外循环时间、手术时间、重症监护病房停留时间、总住院时间以及术后发生急性肺损伤、急性肾损伤、消化道出血、多器官功能障碍综合征、死亡/自动出院比例等方面的差异有统计学意义。多因素分析结果显示,糖尿病史(OR=7.539,95%CI=2.303~24.683,P<0.001)和脑血管病史(OR=4.494,95%CI=1.639~12.325,P=0.004)是患者接受TAAR联合FET术后发生SCI的独立危险因素。结论对于有糖尿病和脑血管病史的急性Stanford A型主动脉夹层患者,应避免术后低血压,预防SCI的发生。 Objective To analyze the risk factors for spinal cord injury(SCI)in patients with acute Stanford type A aortic dissection who received total aortic arch replacement(TAAR)combined with frozen elephant trunk(FET)technique.Methods The clinical data of 698 patients with acute Stanford type A aortic dissection who received TAAR combined with FET in Guangdong Provincial People's Hospital from September 2017 to June 2023 were collected retrospectively.Among them,48 patients with postoperative SCI were set as SCI group,and 650 patients were set as non-SCI group.Multivariate logistic regression was used to analyze the risk factors for postoperative SCI.Results The results of univariate analysis showed that there were significant differences between the two groups in the history of diabetes,history of cerebrovascular disease,fibrinogen content,number of intercostal arteries originating from the false lumen,true lumen area at the level of the 6th,9th and 12th thoracic vertebra,lactate level before cardiopulmonary bypass,aortic clamping time,cardiopulmonary bypass time,operation time,intensive care unit stay time,total hospitalization time,and postoperative acute lung injury,acute kidney injury,gastrointestinal bleeding,multiple organ dysfunction syndrome and death/automatic discharge rate.The results of multivariate analysis showed that the history of diabetes(OR=7.539,95%CI=2.303-24.683,P<0.001)and history of cerebrovascular disease(OR=4.494,95%CI=1.639-12.325,P=0.004)were independent risk factors for SCI in patients undergoing TAAR combined with FET.Conclusion For acute Stanford type A aortic dissection patients with a history of diabetes or cerebrovascular disease,postoperative hypotension should be avoided to prevent the occurrence of SCI.
作者 王成虎 王秋吉 冯玮琪 付彪 吴进林 杨珏 李欣 于长江 范瑞新 Wang Chenghu;Wang Qiuji;Feng Weiqi;Fu Biao;Wu Jinlin;Yang Jue;Li Xin;Yu Changjiang;Fan Ruixin(Guangdong Cardiovascular Institute,Guangdong Provincial People’s Hospital,Guangdong Academy of Medical Sciences,Guangzhou 510080,Guangdong,China;Guangdong Provincial People’s Hospital(Guangdong Academy of Medical Sciences),Southern Medical University,Guangzhou 510080,Guangdong,China)
出处 《中国血管外科杂志(电子版)》 2024年第3期222-226,共5页 Chinese Journal of Vascular Surgery(Electronic Version)
关键词 主动脉夹层 腔内治疗 脊髓损伤 危险因素 Aortic dissection Endovascular treatment Spinal cord injury Risk factors
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