目的了解急性Stanford A型主动脉夹层(stanford type a acute aortic dissection,TAAD)患者术后并发急性肾损伤(acute kidney injury,AKI)的相关因素.方法回顾性收集中南大学湘雅二医院2017年1月—12月接受外科手术治疗的急性Stanford ...目的了解急性Stanford A型主动脉夹层(stanford type a acute aortic dissection,TAAD)患者术后并发急性肾损伤(acute kidney injury,AKI)的相关因素.方法回顾性收集中南大学湘雅二医院2017年1月—12月接受外科手术治疗的急性Stanford A型主动脉夹层患者的病例资料.根据患者术后是否发生AKI,分为AKI组和非AKI组.对两组患者的一般情况、实验室检查、手术时间、手术方式、体外循环相关因素等指标进行比较,并通过多因素回归分析术后急性肾损伤的危险因素,最后绘制受试者工作特征曲线(operating characteristic curve,ROC)评估其预测价值.结果共有126例患者纳入研究,平均年龄(50.1±10.8)岁,其中AKI组共61例,非AKI组共65例.单因素分析显示,两组患者的年龄、术前血清肌酐(Scr)、体外循环时间和夹层累及肾动脉比例的差异具有统计学意义(P<0.05).多因素分析显示,术前Scr水平(OR=1.015,95%CI:1.004~1.027)、体外循环时间(OR=1.004,95%CI:1.000~1.007)和肾动脉受累(OR=2.324,95%CI:1.043~5.179)是术后并发急性肾损伤的独立危险因素.ROC曲线分析显示,术前Scr水平、体外循环时间和肾动脉受累对于术后急性肾损伤的发生均有着一定的预测价值,ROC曲线下面积(area under curve,AUC)分别为0.630、0.630和0.599.结论术前Scr水平、体外循环时间和夹层累及肾动脉是术后并发急性肾损伤的独立危险因素.展开更多
<strong>Background and Aim:</strong> Reports on recovery from Stanford type A aortic dissection (TAAD) leading to cardiopulmonary arrest (CPA) are few. In retrograde TAAD (r-TAAD) cases, some authors repor...<strong>Background and Aim:</strong> Reports on recovery from Stanford type A aortic dissection (TAAD) leading to cardiopulmonary arrest (CPA) are few. In retrograde TAAD (r-TAAD) cases, some authors reported the efficacy of thoracic endovascular aortic repair (TEVAR). However, only a few reports chose TEVAR for the treatment of r-TAAD resulting in cardiac arrest before hospital arrival. We report a case of r-TAAD presenting with cardiac arrest before hospital arrival not indicated for surgery but TEVAR as treatment. <strong>Case: </strong>A 65-year-old woman with a history of Marfan syndrome presented to the emergency department after a CPA. Sequential return of spontaneous circulation was achieved 27 min after CPA. Contrast-enhanced computed tomography showed retrograde r-TAAD with an entry tear to the false lumen in the thoracic descending aorta. Therefore, thoracic endovascular aortic repair (TEVAR) was performed with r-TAAD. Afterward, the clinical course was stabilized. This patient suggests that TEVAR is an effective option for the treatment of patients with hemodynamically unstable r-TAAD, even after CPA. <strong>Conclusion:</strong> TEVAR can lead to a successful recovery from cardiac arrest due to r-TAAD.展开更多
文摘目的了解急性Stanford A型主动脉夹层(stanford type a acute aortic dissection,TAAD)患者术后并发急性肾损伤(acute kidney injury,AKI)的相关因素.方法回顾性收集中南大学湘雅二医院2017年1月—12月接受外科手术治疗的急性Stanford A型主动脉夹层患者的病例资料.根据患者术后是否发生AKI,分为AKI组和非AKI组.对两组患者的一般情况、实验室检查、手术时间、手术方式、体外循环相关因素等指标进行比较,并通过多因素回归分析术后急性肾损伤的危险因素,最后绘制受试者工作特征曲线(operating characteristic curve,ROC)评估其预测价值.结果共有126例患者纳入研究,平均年龄(50.1±10.8)岁,其中AKI组共61例,非AKI组共65例.单因素分析显示,两组患者的年龄、术前血清肌酐(Scr)、体外循环时间和夹层累及肾动脉比例的差异具有统计学意义(P<0.05).多因素分析显示,术前Scr水平(OR=1.015,95%CI:1.004~1.027)、体外循环时间(OR=1.004,95%CI:1.000~1.007)和肾动脉受累(OR=2.324,95%CI:1.043~5.179)是术后并发急性肾损伤的独立危险因素.ROC曲线分析显示,术前Scr水平、体外循环时间和肾动脉受累对于术后急性肾损伤的发生均有着一定的预测价值,ROC曲线下面积(area under curve,AUC)分别为0.630、0.630和0.599.结论术前Scr水平、体外循环时间和夹层累及肾动脉是术后并发急性肾损伤的独立危险因素.
文摘<strong>Background and Aim:</strong> Reports on recovery from Stanford type A aortic dissection (TAAD) leading to cardiopulmonary arrest (CPA) are few. In retrograde TAAD (r-TAAD) cases, some authors reported the efficacy of thoracic endovascular aortic repair (TEVAR). However, only a few reports chose TEVAR for the treatment of r-TAAD resulting in cardiac arrest before hospital arrival. We report a case of r-TAAD presenting with cardiac arrest before hospital arrival not indicated for surgery but TEVAR as treatment. <strong>Case: </strong>A 65-year-old woman with a history of Marfan syndrome presented to the emergency department after a CPA. Sequential return of spontaneous circulation was achieved 27 min after CPA. Contrast-enhanced computed tomography showed retrograde r-TAAD with an entry tear to the false lumen in the thoracic descending aorta. Therefore, thoracic endovascular aortic repair (TEVAR) was performed with r-TAAD. Afterward, the clinical course was stabilized. This patient suggests that TEVAR is an effective option for the treatment of patients with hemodynamically unstable r-TAAD, even after CPA. <strong>Conclusion:</strong> TEVAR can lead to a successful recovery from cardiac arrest due to r-TAAD.
