Debakey Ⅰ型主动脉夹层患者术前低氧血症对预后的影响
发布时间：2018-08-20 10:10
【摘要】：目的:统计Debakey I型主动脉夹层患者围手术期资料,分析术前低氧血症的发生情况,充分评估其对手术及患者预后的影响。方法:全面收集我院近几年行主动脉部分切除伴人工血管置换术的63例Debakey I型主动脉夹层患者的临床资料,对其进行回顾分析。结合欧美联席会议(AECC)对急性呼吸窘迫综合症(Acute Respiratory Distress Syndrome,ARDS)定义及欧洲重症医学会在此基础上提出的柏林定义,根据术前PaO2与 FiO2比值进行分组,将患者分成低氧血症组(氧合指数≤200mmHg,n=22)和非低氧血症组(氧合指数200mmHg,n=41)。排除标准:肺部疾患严重、曾行主动脉夹层手术或有其他器官组织严重疾病的患者。比较两组患者基本情况:年龄、性别、吸烟史、体重指数、术前Hb值、心功能分级(NYHA),术前情况:意识障碍发生率、术前胸闷及呼吸困难发生率,术中情况:低氧血症发生率、体外循环(cardiopulmonary bypass,CPB)时间、心肌阻断时间、深低温停循环(deep hypothermic circulatory arrest,DHCA)时间、术中输血量,术中最低氧分压,术后情况:呼吸机辅助通气时间、重症监护室(Intensive Care Unit,ICU)滞留时间、术后住院时间、术后低氧血症发生率、再次插管率、非呼吸系统并发症发生率及死亡率。结果:1.术前情况:低氧血症组22例,占34.38%,男16例(72.73%),女6例(27.27%),平均年龄(54.29±10.99)岁。非低氧血症组41例,占65.62%,男26例(63.41%),女15例(36.59%),平均年龄(54.20±11.37)岁。经过对年龄、性别、体重指数、吸烟史、术前Hb值、心功能分级(NYHA)的分析,发现两组患者的基本情况无显著差异,在术前精神症状方面,低氧血症组发生率明显比非低氧血症组要高(P0.01),但精神症状严重程度与低氧程度并不一致。术前低氧血症患者尽管都有程度不同的缺氧情况,但这些患者大部分并没有出现呼吸窘迫、胸部闷胀等主观的症状。2.术中情况:比较两组患者CPB时间、心肌血管阻断时间、DHCA时间、术中输血量,两组亦无明显的差别(P0.05)。低氧血症组患者术中出现氧合过低情况的比例明显高于非低氧血症组患者(P0.01),低氧血症组患者术中最低氧分压平均值明显低于非低氧血症组患者(P0.01)。3.术后情况:分析两组患者术后在院期间各项指标,低氧血症组患者呼吸机辅助性通气时间较非低氧血症组患者明显要长(P0.05),低氧血症组为(49.53±21.71)h,非低氧血症组为(25.71±20.83)h。低氧血症组术后低氧血症(PaO2/FiO2≤200mmHg)发生率、ICU滞留时间、术后住院时间均较非低氧血症组显著地增加(P0.05)。低氧血症组及非低氧血症组比较术后再次插管率、非呼吸系统并发症发生率、死亡率,发现无明显统计学差异。结论:低氧血症是主动脉夹层的一个常见并发症,许多主动脉夹层患者在术前合并低氧血症。低氧血症会影响全身组织脏器的功能,对患者术前、术中、术后机体功能产生影响,造成术后呼吸机辅助通气时间、ICU滞留时间、术后住院时间明显延长,并显著增加术中、术后低氧血症发生率,但并没有出现术前低氧血症患者再次插管率、非呼吸系统并发症发生率、死亡率明显增高的情况。
[Abstract]:Objective:To analyze the incidence of preoperative hypoxemia in patients with Debakey type I aortic dissection and to evaluate the prognosis of the patients.Methods:The clinical data of 63 patients with Debakey type I aortic dissection who underwent partial aortic resection and artificial vascular replacement in our hospital in recent years were collected. Based on the definition of Acute Respiratory Distress Syndrome (ARDS) and the Berlin definition proposed by the European Society of Critical Care Medicine, the patients were divided into two groups according to the preoperative PaO2/FiO2 ratio: hypoxemia group (oxygenation index < 200 mmHg, n = 22) and non-hypoxemia group (non-hypoxia index < 200 mmHg, n = 22). Oxygenation index 200 mmHg, n = 41. Exclusion criteria: patients with severe lung disease, aortic dissection or other serious organ and tissue diseases. Comparison of the two groups of patients with basic conditions: age, sex, smoking history, body mass index, preoperative Hb value, cardiac function classification (NYHA), preoperative conditions: incidence of consciousness disorders, preoperative chest tightness and expiration. Incidence of dyspnea, intraoperative conditions: incidence of hypoxemia, cardiopulmonary bypass (CPB), myocardial block time, deep hypothermic circulatory arrest (DHCA), intraoperative blood transfusion, intraoperative minimum oxygen partial pressure, postoperative conditions: ventilator-assisted ventilation time, Intensive Care Un Results: 1. Preoperative conditions: hypoxemia group 22 cases, accounting for 34.38%, 16 males (72.73%), 6 females (27.27%) with an average age of 54.29 [10.99] years. Non-hypoxemia group 41 cases, accounting for 65.62%, 26 males (63.41%) and 26 females (63.41%). Fifteen patients (36.59%) had an average age of (54.20 + 11.37) years. Through the analysis of age, sex, body mass index, smoking history, preoperative Hb value and cardiac function grading (NYHA), it was found that there was no significant difference between the two groups in basic conditions. In preoperative mental symptoms, the incidence of hypoxemia group was significantly higher than that of non-hypoxemia group (P 0.01), but the severity of psychiatric symptoms was longer significant (P 0.01). The degree of hypoxia was not consistent with the degree of hypoxia. Although there were different degrees of hypoxia before operation, most of these patients did not appear respiratory distress, chest stuffiness and other subjective symptoms. The incidence of hypoxemia was significantly higher in the hypoxemia group than that in the non-hypoxemia group (P 0.01). The mean value of the lowest partial pressure of oxygen in the hypoxemia group was significantly lower than that in the non-hypoxemia group (P 0.01). 3. Postoperative situation: The indexes of the two groups were analyzed during the hospital, and the patients in the hypoxemia group were breathed out. The duration of ventilation was significantly longer in the hypoxemia group than in the non-hypoxemia group (P 0.05). The hypoxemia group was (49.53 +21.71) h, and the non-hypoxemia group was (25.71 +20.83) H. The incidence of postoperative hypoxemia (PaO 2/FiO 2 < 200 mmHg) in the hypoxemia group, the ICU retention time and the postoperative hospitalization time were significantly longer than those in the non-hypoxemia group (P 0.05). Conclusion: Hypoxemia is a common complication of aortic dissection. Many patients with aortic dissection complicate with hypoxemia before operation. Hypoxemia can affect the function of organs in the whole body. Preoperative, intraoperative and postoperative impacts on the body function, resulting in postoperative ventilator-assisted ventilation time, ICU stay time, postoperative hospital stay significantly prolonged, and significantly increased the incidence of intraoperative and postoperative hypoxemia, but there was no preoperative hypoxemia in patients with re-intubation rate, non-respiratory complications, mortality rate was significant. High condition.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R614
，
本文编号：2193237
[Abstract]:Objective:To analyze the incidence of preoperative hypoxemia in patients with Debakey type I aortic dissection and to evaluate the prognosis of the patients.Methods:The clinical data of 63 patients with Debakey type I aortic dissection who underwent partial aortic resection and artificial vascular replacement in our hospital in recent years were collected. Based on the definition of Acute Respiratory Distress Syndrome (ARDS) and the Berlin definition proposed by the European Society of Critical Care Medicine, the patients were divided into two groups according to the preoperative PaO2/FiO2 ratio: hypoxemia group (oxygenation index < 200 mmHg, n = 22) and non-hypoxemia group (non-hypoxia index < 200 mmHg, n = 22). Oxygenation index 200 mmHg, n = 41. Exclusion criteria: patients with severe lung disease, aortic dissection or other serious organ and tissue diseases. Comparison of the two groups of patients with basic conditions: age, sex, smoking history, body mass index, preoperative Hb value, cardiac function classification (NYHA), preoperative conditions: incidence of consciousness disorders, preoperative chest tightness and expiration. Incidence of dyspnea, intraoperative conditions: incidence of hypoxemia, cardiopulmonary bypass (CPB), myocardial block time, deep hypothermic circulatory arrest (DHCA), intraoperative blood transfusion, intraoperative minimum oxygen partial pressure, postoperative conditions: ventilator-assisted ventilation time, Intensive Care Un Results: 1. Preoperative conditions: hypoxemia group 22 cases, accounting for 34.38%, 16 males (72.73%), 6 females (27.27%) with an average age of 54.29 [10.99] years. Non-hypoxemia group 41 cases, accounting for 65.62%, 26 males (63.41%) and 26 females (63.41%). Fifteen patients (36.59%) had an average age of (54.20 + 11.37) years. Through the analysis of age, sex, body mass index, smoking history, preoperative Hb value and cardiac function grading (NYHA), it was found that there was no significant difference between the two groups in basic conditions. In preoperative mental symptoms, the incidence of hypoxemia group was significantly higher than that of non-hypoxemia group (P 0.01), but the severity of psychiatric symptoms was longer significant (P 0.01). The degree of hypoxia was not consistent with the degree of hypoxia. Although there were different degrees of hypoxia before operation, most of these patients did not appear respiratory distress, chest stuffiness and other subjective symptoms. The incidence of hypoxemia was significantly higher in the hypoxemia group than that in the non-hypoxemia group (P 0.01). The mean value of the lowest partial pressure of oxygen in the hypoxemia group was significantly lower than that in the non-hypoxemia group (P 0.01). 3. Postoperative situation: The indexes of the two groups were analyzed during the hospital, and the patients in the hypoxemia group were breathed out. The duration of ventilation was significantly longer in the hypoxemia group than in the non-hypoxemia group (P 0.05). The hypoxemia group was (49.53 +21.71) h, and the non-hypoxemia group was (25.71 +20.83) H. The incidence of postoperative hypoxemia (PaO 2/FiO 2 < 200 mmHg) in the hypoxemia group, the ICU retention time and the postoperative hospitalization time were significantly longer than those in the non-hypoxemia group (P 0.05). Conclusion: Hypoxemia is a common complication of aortic dissection. Many patients with aortic dissection complicate with hypoxemia before operation. Hypoxemia can affect the function of organs in the whole body. Preoperative, intraoperative and postoperative impacts on the body function, resulting in postoperative ventilator-assisted ventilation time, ICU stay time, postoperative hospital stay significantly prolonged, and significantly increased the incidence of intraoperative and postoperative hypoxemia, but there was no preoperative hypoxemia in patients with re-intubation rate, non-respiratory complications, mortality rate was significant. High condition.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R614
，
本文编号：2193237
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