摘要
目的探讨新型冠状病毒Omicron变异毒株流行感染背景下对急性A型主动脉夹层(acute type A aortic dissection,ATAAD)患者相较于非流行期的救治策略和预后的影响结果差异。方法回顾性收集新型冠状病毒Omicron变异株流行期间(2022年12月7日到2023年1月10日)以及无疫情流行期间(2019年12月7日至2020年1月10日)ATAAD患者的临床资料,比较两个不同时期ATAAD患者手术策略、围手术期病死率、围手术期并发症发生率等差异。结果感染组患者共14例,无疫情流行期间的对照组共43例。感染组主动脉阻断时间更短[(89.71±16.27)min对(110.09±28.99)min,P<0.01],术后病死率相较对照组明显上升(疫情期间21.43%,非疫情期间2.33%,P=0.02),监护室滞留(疫情期间中位时间3天,非疫情期间中位时间2天,P=0.04)以及气管插管带管时间均明显延长(疫情期间中位时间34 h,非疫情期间中位时间14 h,P<0.01),以脑梗塞为主的不良事件发生率也更高(疫情期间28.57%,非疫情期间6.98%,P=0.03)。结论Omicron变异毒株流行期间,本中心对于新型冠状病毒围感染期患者在手术策略选择上更倾向于较为保守的术式。尽管新冠病毒感染增加了ATAAD术后病死率和并发症发生率,但仍获得了较为满意的治疗效果。因此对于该种类型的患者,仍应积极进行手术治疗。
Objective To investigate the differences in outcomes of surgical strategies and prognosis of patients with acute type A aortic dissection(ATAAD)during the period of COVID-19 Omicron variant epidemic compared with the non-epidemic period.Methods Clinical data were retrospectively collected from ATAAD patients during the COVID-19 Omicron variant epidemic(December 7,2022 to January 10,2023)and during the non-epidemic period(December 7,2019 to January 10,2020)to compare the differences in surgical strategies,perioperative mortality,and perioperative complication rates in ATAAD patients during the two different periods.Results There were 14 patients in the COVID-19 infected group and 43 patients in the control group.Patients in the infected group had a shorter mean aortic clamp time[(89.71±16.27)min vs.(110.09±28.99)min,P<0.01],a significantly higher postoperative mortality rate relative to the control group(21.43%vs.2.33%,P=0.02),a significantly longer length of stay in the ICU(3 days vs.2 days,P=0.04)and the duration of intubation time(34 h vs.14 h,P<0.01),and the incidence of adverse events,mainly cerebral infarction,was higher in infected group(28.57%vs.6.98%,P=0.03).Conclusion During the COVID-19 Omicron variant strain epidemic,our center preferred a more conservative surgical strategy in COVID-19 infected patients.Although the COVID-19 infection increased the postoperative mortality and complication rate of ATAAD,patients still achieve a more satisfactory outcome.Therefore,surgical treatment should be timely performed for ATAAD patients.
作者
张宸翰
杨祎
胡海瓯
葛翼鹏
乔志钰
里程楠
郑军
刘永民
朱俊明
Zhang Chenhan;Yang Yi;Hu Haiou;Ge Yipeng;Qiao Zhiyu;Li Chengnan;Zheng Jun;Liu Yongmin;Zhu Junming(Department of Cardiovascular Surgery,Beijing Aortic Disease Center,Beijing Anzhen Hospital,Capital Medical University,Beijing 100029,China)
出处
《中华胸心血管外科杂志》
CSCD
北大核心
2023年第7期393-397,共5页
Chinese Journal of Thoracic and Cardiovascular Surgery
基金
北京市科技计划项目(Z191100006619093,Z191100006619094)。
