急性A型主动脉夹层术后低氧血症预后及危险因素分析OA
Prognosis and independent risk factors of hypoxemia after acute type A aortic dissection surgery
目的 探讨并分析急性A型主动脉夹层(ATAAD)术后低氧血症发生率、短期预后及独立危险因素.方法 连续纳入2023年1-7月于首都医科大学附属北京安贞医院行手术治疗的ATAAD患者,根据术后48 h内有无发生低氧血症将患者分为低氧血症组[氧合指数(动脉氧分压/吸入氧浓度)≤200 mmHg,PaO2/FiO2≤200 mmHg]及对照组(PaO2/FiO2>200 mmHg),统计比较两组临床特征、手术数据及短期预后,并采用多因素Logistic回归分析独立危险因素.结果 共纳入145例患者,平均年龄(51.82±10.65)岁,共97例(66.9%)发生低氧血症,低氧血症组较对照组ICU天数(3.5 d vs.1.5 d,P<0.001)、机械通气时间(19.5 h vs.12 h,P<0.001)及无创呼吸机使用(27.8%vs.10.4%,P=0.017)、感染(27.8%vs.2.1%,P<0.001)、气管切开(10.3%vs.0%,P=0.031)、腹腔脏器缺血(16.5%vs.4.2%,P=0.035)、连续性肾脏替代治疗(16.5%vs.4.2%,P=0.035)、急性脑血管病(13.4%vs.0%,P=0.005)发生率均明显升高,但两组院内病死率(5.2%vs.0%,P=0.171)无明显差异.多因素Logistic回归分析结果显示年龄(OR=1.079,95%CI:1.027～1.135)、身体质量指数(BMI)(OR=1.406,95%CI:1.203～1.643)、术前C反应蛋白(CRP)(OR=1.020,95%CI:1.006～1.035)、术中最高乳酸(OR=1.670,95%CI:1.025～2.719)及术后48 h输血量(OR=1.013,95%CI:1.000～1.022)是ATAAD术后发生低氧血症的独立预测因子(P<0.05).结论 ATAAD术后低氧血症显著增加并发症风险,年龄、BMI、术前CRP、术中最高乳酸水平及术后48 h输血量是其独立危险因素,早期识别和干预可能改善预后.
Objective To investigate the incidence,short-term prognosis and independent risk factors of hypoxemia after acute type A aortic dissection(ATAAD)surgery.Methods Consecutive patients with ATAAD who underwent surgical treatment at Beijing Anzhen Hospital of Capital Medical University from January 2023 to July 2023 were enrolled.According to the presence or absence of hypoxemia within 48 hours after surgery,patients were divided into a hypoxemia group(oxygen-ation index,arterial partial pressure of oxygenfraction of inspired oxygen PaO2/FiO2≤200 mmHg)and a control group(PaO2/FiO2>200 mmHg).The clinical features,surgical data and short-termoutcomes were compared between the two groups.Multi-variable logistic regression analysis was performed to identify independent risk factors for postoperative hypoxemia.Results A total of 145 patients were included,with an average age of 51.82±10.65 years.A total of 97 patients(66.9%)developed hypox-emia.Compared with the control group,the hypoxemia group had a significantly longer ICU stay(3.5 d vs.1.5 d,P<0.001)and duration of mechanical ventilation(19.5 h vs.12 h,P<0.001),as well as significantly higher rates of noninvasive ventilator use(27.8%vs.10.4%,P=0.017),infection(27.8%vs.2.1%,P<0.001),tracheotomy(10.3%vs.0%,P=0.031),visceral ischemia(16.5%vs.4.2%,P=0.035),continuous renal replacement therapy(CRRT)(16.5%vs.4.2%,P=0.035),and acute cerebrovas-cularevents(13.4%vs.0%,P=0.005).However,there was no significant difference in in-hospital mortality between the two groups(5.2%vs.0%,P=0.171).Multivariable logistic regression showed that age(OR=1.079,95%CI:1.027～1.135),body mass index(BMI)(OR=1.406,95%CI:1.203～1.643),preoperative C-reactive protein(CRP)(OR=1.020,95%CI:1.006～1.035),intraoperative peak lactate(OR=1.670,95%CI:1.025～2.719)and postoperative 48h blood transfusion(OR=1.013,95%CI:1.000～1.022)were independent predictors of hypoxemia after ATAAD surgery(P<0.05).Conclusion Postoperative hypox-emia is associated with a significantly increased risk of postoperative complications.Age,BMI,preoperative CRP,intraoperative peak lactate and postoperative 48h blood transfusion volume are independent risk factors.Early identification and intervention may improve prognosis.
时亚丽;金祺;李呈龙;刘楠;王红;贾明;侯晓彤
首都医科大学附属北京安贞医院心脏外科危重症中心,北京 100029首都医科大学附属北京安贞医院心脏外科危重症中心,北京 100029首都医科大学附属北京安贞医院心脏外科危重症中心,北京 100029首都医科大学附属北京安贞医院心脏外科危重症中心,北京 100029首都医科大学附属北京安贞医院心脏外科危重症中心,北京 100029首都医科大学附属北京安贞医院心脏外科危重症中心,北京 100029首都医科大学附属北京安贞医院心脏外科危重症中心,北京 100029
急性A型主动脉夹层大血管手术低氧血症危险因素预后
acute type A aortic dissectiongreat vessel surgeryhypoxemiarisk factorsprognosis
《中国体外生命支持》 2026 (2)
122-126,131,6
北京市高层次公共卫生技术人才建设项目(领军人才-03-05)
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