Stanford A型主动脉夹层患者主动脉弓手术后发生神经功能障碍的影响因素及其风险预测列线图模型构建OA

Objective To investigate the influencing factors of neurological dysfunction(ND)in patients with Stanford type A aortic dissection(TAAD)after aortic arch surgery and construct its risk prediction nomogram model.Methods A retrospective study was conducted on 196 patients with TAAD admitted to the Department of Cardiovascular Surgery at the First Affiliated Hospital of Air Force Medical University from January 2022 to June 2025.Patients were divided into the ND group(n=67)and the non-ND group(n=129)based on the occurrence of ND after aortic arch surgery.Clinical data of the patients were collected,and multivariate Logistic regression analysis was performed to identify the influencing factors of ND in patients with TAAD after aortic arch surgery.The rms package in R 4.4.1 software was used to construct the risk prediction nomogram model for ND in patients with TAAD after aortic arch surgery.The discrimination,accuracy,and clinical applicability of the nomogram model were evaluated by ROC curve,the Hosmer-Lemeshow goodness-of-fit test,and decision curve.Results In the ND group,the proportions of patients who experienced syncope at onset,had decreased preoperative pulse oxygen saturation(SpO2),underwent coronary artery bypass grafting(CABG),had a bispectral index(BIS)>14 during cardiopulmonary bypass,required delayed chest closure,developed acute kidney injury(AKI)within 48 hours after surgery,and exhibited hypoxemia within 48 hours after surgery were higher than those in the non-ND group,and the duration of selective antegrade cerebral perfusion(SACP)and deep hypothermic circulatory arrest(DHCA)was longer than that in the non-ND group(P<0.05).Multivariate Logistic regression analysis results revealed that syncope at onset,decreased preoperative SpO2,duration of SACP,duration of DHCA,and AKI within 48 hours after surgery were independent influencing factors of ND in patients with TAAD after aortic arch surgery(P<0.05).The risk prediction nomogram model for ND in patients with TAAD after aortic arch surgery was constructed based on syncope at onset,decreased preoperative SpO2,duration of SACP,duration of DHCA,and AKI within 48 hours after surgery.ROC curve analysis results showed that the AUC of the nomogram model in predicting ND in patients with TAAD after aortic arch surgery was 0.930[95%CI(0.890-0.970)].The Hosmer-Lemeshow goodness-of-fit test results indicated that the nomogram model fitted well(χ2=5.387,P=0.716).Decision curve analysis results showed that the net benefit rate of the nomogram model was>0 when the threshold probability was 0.02-0.92 and 0.93-0.97.Conclusion Syncope at onset,decreased preoperative SpO2,duration of SACP,duration of DHCA,and AKI within 48 hours after surgery are influencing factors of ND in patients with TAAD after aortic arch surgery.The risk prediction nomogram model for ND in patients with TAAD after aortic arch surgery,constructed based on the aforementioned indicators in this study,demonstrates good discrimination,accuracy,and clinical applicability.