摘要
目的探讨Stanford A型主动脉夹层患者术后并发重度低氧血症的独立危险因素。方法选取2010年1月至2017年3月在梅州市人民医院接受手术治疗的60例Stanford A型主动脉夹层患者作为研究对象,根据术后48 h是否并发重度低氧血症将上述研究对象分为观察组(11例)与对照组(49例),观察组在术后48 h内动脉血氧分压(arterial oxygen partial pressure,PaO_2)/吸入氧(inhalation oxygen,FiO_2)]/≤100 mmHg(1 mmHg=0.133 k Pa),对照组在术后48 h内PaO_2/FiO_2>100 mmHg。先采用单因素分析比较两组的临床资料,然后再选择有统计意义的指标进行多因素分析。结果单因素分析显示:观察组年龄(χ~2=13.144 7,P=0.000 3)、体质量指数(χ~2=9.539 1,P=0.002 0)、术前血清丙氨酸氨基转移酶(ALT)异常率(χ~2=9.794 8,P=0.001 8)、术前血清肌酐(Cr)异常率(χ~2=8.135 5,P=0.004 3)、术前血清肌红蛋白(Mb)异常率(χ~2=16.771 7,P=0.000 0)、术后连续肾脏替代疗法(CRRT)使用率(χ~2=11.721 2,P=0.000 6)显著高于对照组,差异有统计学意义;两组性别(χ~2=0.292 0,P=0.612 9)、体外循环时间(t=0.921,P=0.361)、术后48 h内再开胸率(χ~2=1.301 0,P=0.255 5)、呼吸系统疾病史(χ~2=0.057 1,P=0.830 4)、心脏手术史(χ~2=0.184 9,P=0.689 3)比较,差异无统计学意义。多因素分析:年龄(Wald χ~2=4.241 0,P=0.039 5)、体质量指数(Wald χ~2=5.752 2,P=0.016 5)、术前血清丙氨酸氨基转移酶异常(Wald χ~2=6.239 1,P=0.012 5)、术前血清肌酐异常(Wald χ~2=5.228 9,P=0.022 2)、术前血清肌红蛋白异常(Wald χ~2=5.554 2,P=0.018 4)是Stanford A型主动脉夹层患者术后并发重度低氧血症的独立危险因素,术后连续肾脏替代疗法使用(Wald χ~2=2.639 2,P=0.104 3)是其非独立危险因素。结论 Stanford A型主动脉夹层患者术后并发重度低氧血症的独立危险因素较多,临床应根据这些因素针对性地给予干预措施,以降低重度低氧血症发生率,从而改善患者的预后。
Objectives To investigate the independent risk factors of severe hypoxemia in patients with Stanford type A aortic dissection.Methods Totally 60 patients with Stanford type A aortic dissection underwent surgical treatment from January 2010 to March 2017 in Meizhou City People′s Hospital were selected as research objects.According to whether occuring 48 h postoperative hypoxemia,the patients were divided into observation group(11 cases)and control group(49 cases).Postoperative 48 h arterial oxygen partial pressure(PaO2)/inhalation oxygen(FiO2)in observation group was less than 100 mmHg(1 mmHg=0.133 kPa),and in control group,postoperative 48 h PaO2/FiO2>100 mmHg.Univariate analysis was used to compare the clinical data and indicators of the two groups,and then selected statistical indicators for multivariate analysis.Results Univariate analysis showed that age(χ2=13.144 7,P=0.000 3),body mass index(χ2=9.539 1,P=0.002 0),preoperative serum alanine aminotransferase(ALT)abnormality rate(χ2=9.794 8,P=0.001 8),serum creatinine(Cr)abnormality rate(χ2=8.135 5,P=0.004 3),preoperative serum myoglobin(Mb)abnormality rate(χ2=16.771 7,P=0.000 0),postoperative continuous renal replacement therapy(CRRT)use rate(χ2=11.721 2,P=0.000 6)in observation group were significantly higher than those in control group,the differences were statistically significant.There were no significant differences of gender(χ2=0.292 0,P=0.612 9),cardiopulmonary bypass duration(t=0.921,P=0.361),48 h rethoracotomy rate after operation(χ2=1.301 0,P=0.255 5),history of respiratory disease(χ2=0.057 1,P=0.830 4),history of cardiac surgery(χ2=0.184 9,P=0.689 3)between the two groups.Multiple factors analysis indicated that age(Waldχ2=4.241 0,P=0.039 5),body mass index(Waldχ2=5.752 2,P=0.016 5),abnormal serum ALT before operation(Waldχ2=6.239 1,P=0.012 5),abnormal serum Cr before operation(Waldχ2=5.228 9,P=0.022 2),abnormal serum Mb before operation(Waldχ2=5.554 2,P=0.018 4)were independent risk factors associated with severe hypoxemia in patie
作者
黄思纳
欧斌
张剑彬
HUANG Si-na;OU Bin;ZHANG Jian-bin(Major Cardiovascular Surgery,Meizhou City People′s Hospital,Meizhou,Guangdong 514031,China)
出处
《岭南心血管病杂志》
2018年第4期433-436,共4页
South China Journal of Cardiovascular Diseases
