急性Stanford A型主动脉夹层围手术期低氧血症危险因素分析

发布时间：2018-08-02 21:31

【摘要】：目的本研究目的在探讨急性Stanford A型主动脉夹层患者发生术前低氧血症及术后低氧血症相关危险因素。方法回顾性研究分析南京鼓楼医院心胸外科自2013年1月份至2014年1月份急诊入院急性Stanford A型主动脉夹层患者的年龄、性别、体重指数(body mass index,BMI)、高血压病史、吸烟史等基本资料信息及患者术前动脉氧饱和度、术后24小时内患者氧合指数(PaO2/FiO2)、术前白细胞计数、术前中性粒细胞百分比、术前血红蛋白浓度、术前凝血酶原时间、术前C反应蛋白水平、术前乳酸水平、术后24小时内患者血红蛋白浓度、体外循环转流时间、术中深低温停循环时间、术中最低直肠温度、术中输血总量等临床资料。术前及术后的低氧血症皆定义为：氧合指数低于300 (Pa02/Fi02300)。采用t检验、卡方检验、Mann-Whitney U检验、单因素分析、多因素Logistic回归及ROC曲线分析患者的一般情况及相关实验室检查资料和术中相关资料与低氧血症的关系。结果本研究排除资料不全的患者,共入组急性Stanford A型患者45例。入选的患者中男性有37例(82%),女性有8例(18%),平均年龄在49.6±13.0岁,男性、女性患者的平均年龄无明显差别(49.05±12.2岁VS52.1±16.7岁,P0.05)。所有患者的平均体重指数为25.3±2.7(kg／m2)。所有患者中高血压病患者有31例(69%)；有吸烟史的患者有13例(29%)。所有患者的术前平均氧合指数为284.6±91.1,其中有24例(53.3%)的患者发生术前低氧血症,术前低氧血症组的术前氧合指数为220.1±61.7,术前非低氧血症组患者的术前平均氧合指数为358.2±56.7,(P0.05)。所有患者的术前白细胞计数平均为10.1±3.210^9/L,术前中性粒细胞百分比平均80.4±10.7%,术前C反应蛋白水平平均为11.6±9.4mg/L,术前血红蛋白浓度的中位数为125g/L,术前凝血酶原时间平均13.6±2.3s,术前乳酸水平平均2.3±2.5mmol/L。患者术后平均氧合指数为209.2±87.1,其中38例(84%)的患者发生术后低氧血症,术后低氧血症组患者的术后氧合指数为182.3±63.9,术后非低氧组患者的术后氧合指数为355.1±31.5,(P0.05)。患者术后血红蛋白浓度平均11.1±2.2g/L,体外循环转流时间平均253.4±74.3min,深低温停循环时间平均30±8.6min,术中最低直肠温平均19.7±2.8℃,术中输血量中位数在2800ml。多因素Logistic回归分析急性Stanford A型主动脉夹层术前低氧血症危险因素为术前C反应蛋白水平(OR:1.176,95%CI:1.025-1.348)。多因素Logistic回归分析急性Stanford A型主动脉夹层术后低氧血症危险因素为术中输血量(OR:1.005,95%CI:1.001-1.010)。结论1、急性Stanford A型主动脉夹层患者围手术期低氧血症发生率较高,是一种常见的并发症。2、急性Stanford A型主动脉夹层患者术前低氧血症的独立危险因素为术前C反应蛋白水平。3、急性Stanford A型主动脉夹层患者术后低氧血症的独立危险因素为术中输血量。4、急性Stanford A型主动脉夹层患者术前氧合指数与体重指数存在一定相关性。5、急性Stanford A型主动脉夹层患者术后低氧血症与术前氧合指数存在一定相关性。
[Abstract]:Objective the purpose of this study was to investigate the risk factors associated with preoperative hypoxemia and postoperative hypoxemia in patients with acute Stanford A aortic dissection. Methods a retrospective study was conducted to analyze the age, sex, and body of patients with acute Stanford A aortic dissection from January 2013 to January 2014 of Nanjing Gulou Hospital. The body mass index (BMI), the history of hypertension, the history of smoking, the preoperative arterial oxygen saturation, the oxygenation index (PaO2/FiO2), the preoperative leucocyte count, the preoperative neutrophils percentage, preoperative hemoglobin concentration, preoperation hemoglobin concentration, preoperation time of prothrombin, preoperative C reactive protein and preoperative lactate Hemoglobin concentration, cardiopulmonary bypass time, deep hypothermia cycle time, minimum rectal temperature, intraoperative blood transfusion, preoperative and postoperative hypoxemia were defined as: oxygen index was lower than 300 (Pa02/ Fi02300). T test, chi square test, and Mann-Whitney U test were used. Factor analysis, multiple factor Logistic regression and ROC curve analysis of patients' general situation, related laboratory examination data and the relationship between intraoperative data and hypoxemia. Results 45 cases of acute Stanford A patients were enrolled in this study. There were 37 cases (82%) and 8 women (18%) in women. The average age of men and women was 49.6 + 13 years old (49.05 + 12.2 years VS52.1 + 16.7 years, P0.05). The average body mass index of all patients was 25.3 + 2.7 (kg / m2). There were 31 patients (69%) in all patients with hypertension and 13 patients (29%) with the history of smoking. The average preoperative oxygenation index of all patients was 284.6 + 9. 1.1, 24 cases (53.3%) had preoperative hypoxemia, the preoperative hypoxemia group was 220.1 + 61.7 and the preoperative average oxygenation index was 358.2 + 56.7 (P0.05). The average number of preoperative leukocyte counts in all patients was 10.1 + 3.210^9/L, and the average percentage of neutrophils before operation was 80.4 +. 10.7%, the average level of C reactive protein was 11.6 + 9.4mg/L before operation, the median of pre operation hemoglobin concentration was 125g/L, the preoperation prothrombin time was 13.6 + 2.3S, the average preoperative lactic acid level was 209.2 + 87.1 after operation, and 38 patients (84%) had postoperative hypoxemia, and postoperative hypoxemia group suffered from hypoxemia. The postoperative oxygenation index was 182.3 + 63.9, and the postoperative oxygenation index was 355.1 + 31.5 (P0.05). The average hemoglobin concentration was 11.1 + 2.2g/L, cardiopulmonary bypass time averaged 253.4 74.3min, deep hypothermia cycle time averaged 30 + 8.6min, and the minimum rectal temperature was 19.7 + 2.8 C during the operation, and the amount of blood transfusion during the operation. The median risk factor for acute Stanford A type aortic dissection preoperation hypoxemia was the preoperative C reactive protein level (OR:1.176,95%CI:1.025-1.348) in the 2800ml. multiple factor Logistic regression analysis. The risk factors for hypoxemia after acute Stanford A aortic dissection were intraoperative blood transfusion (OR:1.005,95%CI:1.0) by multiple factor Logistic regression (OR:1.005,95%CI:1.0). 01-1.010) conclusion 1. The incidence of perioperative hypoxemia in patients with acute Stanford A aortic dissection is high and is a common complication of.2. The independent risk factor for preoperative hypoxemia in patients with acute Stanford A aortic dissection is the preoperative C reaction protein level.3, and postoperative hypoxemia in patients with acute Stanford A type aortic dissection. The independent risk factor was intraoperative blood transfusion.4. There was a certain correlation between preoperative oxygen index and body mass index (.5) in patients with acute Stanford A type aortic dissection. There was a certain correlation between postoperative hypoxemia and preoperative oxygenation index in patients with acute Stanford A type aortic dissection.
【学位授予单位】：东南大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R654.2

【相似文献】