摘要
目的探讨影响行深低温停循环顺行性脑灌注主动脉弓置换术患者院内死亡的危险因素。方法回顾性分析2005年1月至2011年12月626例行深低温停循环顺行性脑灌注主动脉弓部手术患者的资料，记录院内死亡病例死亡原因，将病例按照是否院内死亡分为两组进行单因素分析，将单因素分析具有统计学差异的变量进行logistic回归多因素分析。结果29例（4．6％）发生院内死亡，其中主动脉夹层破裂2例，严重神经系统并发症5例，低心排血量综合征11例，多脏器功能衰竭11例。Logistw回归多因素分析显示，卒中史（OR=6．703，95％CI：1.664～27．000，P=0．007）、术前循环不稳定（OR=6．441，95％CI：1．213～34．212，P=0．029）、体外循环时间（OR=1．008，95％CI：1．002～1．014，P=0．007）、冠状动脉旁路移植手术（OR=4．525，95％C1：1．542～13．279，P=0．006）是院内死亡的独立危险因素。结论卒中史、术前循环不稳定及同期行冠状动脉旁路移植术患者预示着较高的手术风险，提高手术技术缩短体外循环时间可能减少手术死亡。
Objective To analyze risk factors for in-hospital death of aortic arch replacement under deep hypothermic circulatory arrest and antegrade cerebral perfusion. Methods Between January 2005 and December 2011, 626 cases aortic arch replacement under deep hypothermic circulatory arrest and antegrade cerebral perfusion were retrospectively analyzed. The cause of death were recorded and univariate and multivariate analysis （ multiple logistic regression） were used to identity the risk factors. Results In-hospital death occurred in 29 cases （4.6%） and in them 2 cases because of aortic dissection rup- ture, 5 cases severe neurological injury, 11 cases low cardiac output syndrome and 11 cases muhiple organ failure. Multiple lo- gistic regression showed that stroke history （ OR = 6. 703,95 % CI： 1. 664 - 27. 000, P = 0. 007 ）, preoperative hemodynamie in- stability （ OR = 6.441, 95 % CI： 1.213 - 34.212, P = 0. 029 ）, cardiopulmonary bypass time （ OR = 1. 008,95 % CI： 1. 002 - 1.014, P = 0. 007 ） and CABG （ OR = 4. 525,95 % CI： 1. 542 - 13. 279, P = 0. 006 ） were independent risk factors for in-hospi- tal death. Conclusion Stroke history, preoperative hemodynamic instability and coronary involvement indicate high risk in op- eration, and mortality maybe can be reduced by controlling CPB time.
出处
《中华胸心血管外科杂志》
CSCD
北大核心
2014年第5期290-292,共3页
Chinese Journal of Thoracic and Cardiovascular Surgery
关键词
主动脉弓
心脏外科手术
深低温停循环
顺行性脑灌注
死亡率
Aortic arch Cardiac surgical procedm^s Deep hypothermic circulatory arrest Antegrade cerebral perfusion
