Standfor A型主动脉夹层围手术期死亡危险因素分析

发布时间：2018-04-28 04:03

  本文选题：Standford + A型主动脉夹层　； 参考：《新疆医科大学》2015年硕士论文

【摘要】：目的：分析讨论影响Standford A型主动脉夹层住院患者围手术期死亡的相关危险因素。方法：回顾性收集、分析新疆医科大学第一附属医院心脏外科2006年1月至2014年12月收治的127例Standford A型主动脉夹层患者为研究对象,其中,生存组109例,死亡组18例,其中男性91例,女性36例,年龄(61.9±13.6)岁。比较分析两组患者术后转归的年龄,性别,是否合并糖尿病、高尿酸血症、肾功能不全等既往史,心包填塞的存在与否等临床症状、体征,以及高血压知晓情况,吸烟、饮酒史等可能相关因素,采用多因素logistic回归分析筛选主动脉夹术后急性期的危险因素。结果：127例Standford A型主动脉夹层患者围手术期总死亡18例,死亡率为14.17%；经单、多因素logistic回归分析：高龄患者(年龄大于60岁)、吸烟使、高血压病史、术前左心功能较差(LVEF小于50%),肾功能不全(血肌酐大于130pmol/L)、存在心包积液、体外循环时间大于180 min以及主动脉阻断时间大于120 min与术后围手术期死亡有显著关系,肾功能不全(血肌酐大于130pmol/L)患者5例,死亡3例P值为0.001,多因素回归分析结果：回归系数为3.918,标准误为1.407,95%CI：1.159-6.676。P值为0.005。结论：高龄患者(年龄大于60岁)、吸烟使、高血压病史、术前左心功能较差(LVEF小于50%),肾功能不全(血肌酐大于130pmol/L)、存在心包积液、体外循环时间大于180 min以及主动脉阻断时间大于120 min与术后早期死亡有显著关系,其中肾功能不全(血肌酥"g130pmol/L)是术后早期死亡的独立危险因素包填塞,伴发上述病变可使Standford A型主动脉夹层患者发生急性期死亡的危险明显升高,应积极进行血管活性药物的保护性降压控制,进行紧急手术或大血管腔内介入治疗等应对措施。
[Abstract]:Objective: to analyze the risk factors of perioperative death in inpatients with Standford A aortic dissection. Methods: a retrospective study was conducted on 127 patients with Standford A aortic dissection admitted from January 2006 to December 2014 in Cardiac surgery, the first affiliated Hospital of Xinjiang Medical University, including 109 patients in survival group and 18 patients in death group. There were 91 males and 36 females aged 61.9 卤13.6 years. The age, sex, diabetes mellitus, hyperuricemia, renal insufficiency and other clinical symptoms, signs, hypertension and smoking were compared between the two groups, including age, sex, diabetes mellitus, hyperuricemia, renal insufficiency, and the presence or absence of pericardial tamponade. The risk factors of acute stage after aortic clamp operation were screened by multivariate logistic regression analysis. Results among 127 patients with Standford A aortic dissection, 18 died during perioperative period, the mortality rate was 14.17.The single, multivariate logistic regression analysis showed that the elderly patients (age > 60 years, smoking, hypertension history), Preoperative left ventricular dysfunction (LVEF < 50), renal insufficiency (serum creatinine > 130 mmol / L, pericardial effusion, cardiopulmonary bypass time > 180 min and aortic occlusion time > 120 min) were significantly associated with perioperative mortality. There were 5 cases of renal insufficiency (serum creatinine > 130 mmol / L) and 3 cases of death (P = 0.001). The regression coefficient was 3.918 and the standard error was 1.407 CI: 1.159-6.676.P was 0.005. Conclusion: elderly patients (age > 60 years old, smoking, history of hypertension, poor left ventricular function before operation, LVEF < 50), renal insufficiency (serum creatinine > 130 pmol / L), pericardial effusion, pericardial effusion. Cardiopulmonary bypass time was more than 180 min and aortic occlusion time was more than 120 min. Renal insufficiency (g130 pmol / L) was an independent risk factor for early postoperative death. The risk of acute death in patients with Standford A aortic dissection can be significantly increased by the above pathological changes. The protective hypotension control of vasoactive drugs and emergency operation or endovascular intervention should be actively carried out in patients with Standford A aortic dissection.
【学位授予单位】：新疆医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R654.2
，

本文编号：1813680