胸部主动脉血管置换围手术期危险因素分析

发布时间：2018-06-17 21:22

  本文选题：胸部主动脉 + 血管置换　； 参考：《宁夏医科大学》2015年硕士论文

【摘要】：目的本研究通过观察我科107例胸部主动脉血管疾病的患者的手术治疗效果,收集临床资料,进行回顾性研究,分析接受外科手术治疗的胸部主动脉血管疾病的患者围术期的危险因素,总结并归纳,以期为临床未来的治疗起到一定的参考作用。方法1.筛选2005年1月至2014年6月期间于宁夏医科大学总医院心脏中心大血管外科的胸部主动脉疾病的患者(包括升主动脉瘤、马凡综合症、Stanford A型主动脉夹层等)的临床资料共107例为研究总体进行回顾性分析。2.收集我科接受手术治疗的胸主动脉疾病患者的临床资料,分为两大组:未涉及主动脉弓部手术组:年龄、性别、心功能NYHA分级、高血压病史、冠心病病史、吸烟史、主动脉直径、术前EF值、手术时间、CPB时间、ACC时间、同期手术、术后气管插管辅助呼吸时间、术后12小时引流量、术后ICU停留时间;涉及主动脉弓部手术组:年龄、性别、高血压病史、吸烟史、手术期限、术前肾功能不全、手术时间、CPB时间、ACC时间、停循环时间、术后气管插管辅助呼吸时间、术后ICU停留时间。3.使用SPSS 18.0对资料进行单因素分析,然后采用Logistic回归对与死亡相关的具有统计意义的单因素进行多因素分析,筛选出具有统计意义的独立危险因素。4.对本研究中得出的结果进行归纳总结。结果1.未涉及主动脉弓部手术组共73例,死亡率是9.6%(7/73),与死亡相关的主要因素有:年龄大于60岁,吸烟,EF值50%,手术时间≥310min,ACC时间≥120min,CPB时间≥180min,术后12h引流量≥560ml,呼吸机辅助呼吸时间≥65小时,监护室停留时间≥90小时。涉及主动脉弓部手术组共34例,死亡率是:26.5%(9/34),与死亡相关的主要因素有:性别,术前肾功能不全,急诊手术,CPB时间≥180min,ACC时间≥120min。2.采用Logistic回归对单因素进行多因素分析,未涉及主动脉弓部手术组与死亡相关的独立危险因素为:CPB时间,呼吸机辅助时间;涉及主动脉弓部手术组与死亡相关的独立危险因素为:术前肾功能不全,ACC时间。结论1.CPB时间≥180min及呼吸机辅助呼吸时间≥65h是未涉及主动脉弓部的胸部主动脉血管置换手术预测术后早期死亡的独立危险因素。2.术前肾功能不全及ACC时间≥120min是涉及主动脉弓部的胸部主动脉血管置换手术预测术后早期死亡的独立危险因素。3.本研究为单中心研究,样本量较小,临床数据存在部分缺失,对研究的最终结果可能会产生一定的影响,讨论不够全面,仍需长期观察并验证。
[Abstract]:Objective to study the clinical data of 107 patients with thoracic aortic vascular disease in our department. The perioperative risk factors of patients with thoracic aortic vascular diseases undergoing surgical treatment were analyzed, summarized and summarized in order to serve as a reference for future clinical treatment. Method 1. Screening of patients (including ascending aortic aneurysms) with thoracic aortic diseases (including ascending aortic aneurysms) from January 2005 to June 2014 in the Department of Cardiovascular surgery, Cardiac Center, General Hospital of Ningxia Medical University, The clinical data of 107 patients with Marfan's syndrome (Stanford A aortic dissection et al.) were analyzed retrospectively. The clinical data of patients with thoracic aortic disease undergoing surgical treatment were collected and divided into two groups: age, sex, NYHA classification of cardiac function, history of hypertension, history of coronary heart disease, and history of smoking. Aortic diameter, preoperative EF, CPB time and ACC time, simultaneous operation, tracheal intubation assisted respiration time, postoperative 12 hours drainage, postoperative ICU stay time, involved aortic arch operation group: age, sex, History of hypertension, history of smoking, duration of operation, preoperative renal insufficiency, CPB time, ACC time, circulatory arrest time, tracheal intubation assisted respiration time, postoperative ICU stay time. SPSS 18.0 was used for univariate analysis, and logistic regression was used for multivariate analysis of the statistical single factor associated with death. The independent risk factors with statistical significance were screened out. 4. The results of this study are summarized. Result 1. There were 73 cases in the group not involved in aortic arch surgery. The mortality rate was 9.67% of 73%. The main factors associated with death were: age over 60 years old. The EF value of smoking was 50%, the operation time 鈮，

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