摘要
目的探讨导致Stanford A型主动脉夹层患者术后ICU停留时间延长的风险因素,并观察时间延长对于临床预后的影响。方法回顾性分析2018年12月—2022年9月安徽医科大学第一附属医院心脏大血管外科收治的100例Stanford A型患者的围手术期临床资料,根据术后在ICU停留时间是否超过7 d将患者分为ICU常规组(<7 d,65例)和ICU延长组(≥7 d,35例)。对于患者术前及术中临床资料予以单因素分析,将单因素分析差异有统计学意义的变量纳入logistic回归分析并研究ICU停留时间延长的独立风险因素。结果单因素分析显示,2组患者急诊手术(P<0.001)、术前尿素氮水平(P=0.001)、术前血糖水平(P=0.048)、体外循环时间(P=0.009)和手术时间(P=0.010)差异均有统计学意义。将上述因素纳入logistic回归分析,结果显示急诊手术(OR=0.192,P=0.003)、术前尿素氮水平(OR=0.775,P=0.013)和体外循环时间(OR=0.988,P=0.014)均是夹层术后ICU停留时间延长的独立影响因素。ROC曲线显示,3个变量联合预测价值(AUC=0.810)高于3个因素单独预测(急诊手术AUC=0.308、术前尿素氮水平AUC=0.288、体外循环时间AUC=0.340)。术后资料比较显示,2组患者四肢活动障碍(P<0.001)、脏器严重损伤(P<0.001)、气管切开(P<0.001)、72 h内拔除气管插管(P<0.001)、12 h内神志清醒(P<0.001)、离院方式(P<0.001)和住院时间(P=0.037)差异均有统计学意义。结论急诊手术、术前尿素氮水平和体外循环时间是Stanford A型患者术后ICU停留时间延长的影响因素,ICU延长组患者临床预后不良事件发生率较ICU常规组显著升高。针对风险因素采取积极的应对措施,有助于缩短患者术后ICU停留时间,改善临床转归。
Objective To explore the risk factors of postoperative prolonged ICU stay for the patients with Stanford type A aortic dissection and assessed the influence on the clinical outcome due to prolonged ICU stay.Methods A total of 100 patients with Stanford type A aortic dissection admitted in the Department of Cardiovascular Surgery,the First Affiliated Hospital of Anhui Medical University from December 2018 to September 2022 were enrolled as subjects.The clinical material of all patients was collected and analyzed retrospectively.The preoperative and intraoperative material for the patients in two groups were tested using univariate analysis,regular ICU stay(<7 days,65 cases)and prolonged ICU stay(≥7 days,35 cases)based on the period in ICU and then the obtained significant variates were tested using logistic regression to determine the independent risk factors.Results Emergency surgery(P<0.001),preoperative blood nrea nitrogen(P=0.001),preoperative glucose(P=0.048),cardiopulmonary bypass time(P=0.009)and operating time(P=0.010)were considered as significant variates using univariate analysis.Further,based on the findings of logistic regression,emergency surgery(OR=0.192,P=0.003),preoperative blood urea nitrogen(OR=0.775,P=0.013)and cardiopulmonary bypass time(OR=0.988,P=0.014)were identified as the independent risk factors of postoperative prolonged ICU stay.In the predictive model,the combination of all three factors(AUC=0.810)was more effective than any single factor(AUC=0.308,0.288 and 0.340).For the clinical outcome assessment,there were significance on the disability of limbs(P<0.001),severe organic injury(P<0.001),tracheotomy(P<0.001),extubation within 72 h after surgery(P<0.001),awaking within 12 h after surgery(P<0.001),discharging(P<0.001)and hospital stay(P=0.037)in two groups.Conclusion Emergency surgery,preoperative urea nitrogen and cardiopulmonary bypass time are the risk factors of postoperative prolonged ICU stay and compared with the regular ICU stay group,the incidences of adverse events in the
作者
刘海渊
高晴云
张成鑫
龚文辉
葛圣林
LIU Haiyuan;GAO Qingyun;ZHANG Chengxin;GONG Wenhui;GE Shenglin(Department of Cardiovascular Surgery,the First Affiliated Hospital of Anhui Medical University,Hefei,Anhui 230022,China)
出处
《中华全科医学》
2024年第7期1125-1128,1178,共5页
Chinese Journal of General Practice
基金
安徽省自然科学基金项目(1908085MH241)。
