發(fā)布時間：2018-08-20 10:10

【摘要】：目的:統(tǒng)計Debakey I型主動脈夾層患者圍手術(shù)期資料,分析術(shù)前低氧血癥的發(fā)生情況,充分評估其對手術(shù)及患者預(yù)后的影響。方法:全面收集我院近幾年行主動脈部分切除伴人工血管置換術(shù)的63例Debakey I型主動脈夾層患者的臨床資料,對其進(jìn)行回顧分析。結(jié)合歐美聯(lián)席會議(AECC)對急性呼吸窘迫綜合癥(Acute Respiratory Distress Syndrome,ARDS)定義及歐洲重癥醫(yī)學(xué)會在此基礎(chǔ)上提出的柏林定義,根據(jù)術(shù)前PaO2與 FiO2比值進(jìn)行分組,將患者分成低氧血癥組(氧合指數(shù)≤200mmHg,n=22)和非低氧血癥組(氧合指數(shù)200mmHg,n=41)。排除標(biāo)準(zhǔn):肺部疾患嚴(yán)重、曾行主動脈夾層手術(shù)或有其他器官組織嚴(yán)重疾病的患者。比較兩組患者基本情況:年齡、性別、吸煙史、體重指數(shù)、術(shù)前Hb值、心功能分級(NYHA),術(shù)前情況:意識障礙發(fā)生率、術(shù)前胸悶及呼吸困難發(fā)生率,術(shù)中情況:低氧血癥發(fā)生率、體外循環(huán)(cardiopulmonary bypass,CPB)時間、心肌阻斷時間、深低溫停循環(huán)(deep hypothermic circulatory arrest,DHCA)時間、術(shù)中輸血量,術(shù)中最低氧分壓,術(shù)后情況:呼吸機輔助通氣時間、重癥監(jiān)護(hù)室(Intensive Care Unit,ICU)滯留時間、術(shù)后住院時間、術(shù)后低氧血癥發(fā)生率、再次插管率、非呼吸系統(tǒng)并發(fā)癥發(fā)生率及死亡率。結(jié)果:1.術(shù)前情況:低氧血癥組22例,占34.38%,男16例(72.73%),女6例(27.27%),平均年齡(54.29±10.99)歲。非低氧血癥組41例,占65.62%,男26例(63.41%),女15例(36.59%),平均年齡(54.20±11.37)歲。經(jīng)過對年齡、性別、體重指數(shù)、吸煙史、術(shù)前Hb值、心功能分級(NYHA)的分析,發(fā)現(xiàn)兩組患者的基本情況無顯著差異,在術(shù)前精神癥狀方面,低氧血癥組發(fā)生率明顯比非低氧血癥組要高(P0.01),但精神癥狀嚴(yán)重程度與低氧程度并不一致。術(shù)前低氧血癥患者盡管都有程度不同的缺氧情況,但這些患者大部分并沒有出現(xiàn)呼吸窘迫、胸部悶脹等主觀的癥狀。2.術(shù)中情況:比較兩組患者CPB時間、心肌血管阻斷時間、DHCA時間、術(shù)中輸血量,兩組亦無明顯的差別(P0.05)。低氧血癥組患者術(shù)中出現(xiàn)氧合過低情況的比例明顯高于非低氧血癥組患者(P0.01),低氧血癥組患者術(shù)中最低氧分壓平均值明顯低于非低氧血癥組患者(P0.01)。3.術(shù)后情況:分析兩組患者術(shù)后在院期間各項指標(biāo),低氧血癥組患者呼吸機輔助性通氣時間較非低氧血癥組患者明顯要長(P0.05),低氧血癥組為(49.53±21.71)h,非低氧血癥組為(25.71±20.83)h。低氧血癥組術(shù)后低氧血癥(PaO2/FiO2≤200mmHg)發(fā)生率、ICU滯留時間、術(shù)后住院時間均較非低氧血癥組顯著地增加(P0.05)。低氧血癥組及非低氧血癥組比較術(shù)后再次插管率、非呼吸系統(tǒng)并發(fā)癥發(fā)生率、死亡率,發(fā)現(xiàn)無明顯統(tǒng)計學(xué)差異。結(jié)論:低氧血癥是主動脈夾層的一個常見并發(fā)癥,許多主動脈夾層患者在術(shù)前合并低氧血癥。低氧血癥會影響全身組織臟器的功能,對患者術(shù)前、術(shù)中、術(shù)后機體功能產(chǎn)生影響,造成術(shù)后呼吸機輔助通氣時間、ICU滯留時間、術(shù)后住院時間明顯延長,并顯著增加術(shù)中、術(shù)后低氧血癥發(fā)生率,但并沒有出現(xiàn)術(shù)前低氧血癥患者再次插管率、非呼吸系統(tǒng)并發(fā)癥發(fā)生率、死亡率明顯增高的情況。
[Abstract]:Objective:To analyze the incidence of preoperative hypoxemia in patients with Debakey type I aortic dissection and to evaluate the prognosis of the patients.Methods:The clinical data of 63 patients with Debakey type I aortic dissection who underwent partial aortic resection and artificial vascular replacement in our hospital in recent years were collected. Based on the definition of Acute Respiratory Distress Syndrome (ARDS) and the Berlin definition proposed by the European Society of Critical Care Medicine, the patients were divided into two groups according to the preoperative PaO2/FiO2 ratio: hypoxemia group (oxygenation index < 200 mmHg, n = 22) and non-hypoxemia group (non-hypoxia index < 200 mmHg, n = 22). Oxygenation index 200 mmHg, n = 41. Exclusion criteria: patients with severe lung disease, aortic dissection or other serious organ and tissue diseases. Comparison of the two groups of patients with basic conditions: age, sex, smoking history, body mass index, preoperative Hb value, cardiac function classification (NYHA), preoperative conditions: incidence of consciousness disorders, preoperative chest tightness and expiration. Incidence of dyspnea, intraoperative conditions: incidence of hypoxemia, cardiopulmonary bypass (CPB), myocardial block time, deep hypothermic circulatory arrest (DHCA), intraoperative blood transfusion, intraoperative minimum oxygen partial pressure, postoperative conditions: ventilator-assisted ventilation time, Intensive Care Un Results: 1. Preoperative conditions: hypoxemia group 22 cases, accounting for 34.38%, 16 males (72.73%), 6 females (27.27%) with an average age of 54.29 [10.99] years. Non-hypoxemia group 41 cases, accounting for 65.62%, 26 males (63.41%) and 26 females (63.41%). Fifteen patients (36.59%) had an average age of (54.20 + 11.37) years. Through the analysis of age, sex, body mass index, smoking history, preoperative Hb value and cardiac function grading (NYHA), it was found that there was no significant difference between the two groups in basic conditions. In preoperative mental symptoms, the incidence of hypoxemia group was significantly higher than that of non-hypoxemia group (P 0.01), but the severity of psychiatric symptoms was longer significant (P 0.01). The degree of hypoxia was not consistent with the degree of hypoxia. Although there were different degrees of hypoxia before operation, most of these patients did not appear respiratory distress, chest stuffiness and other subjective symptoms. The incidence of hypoxemia was significantly higher in the hypoxemia group than that in the non-hypoxemia group (P 0.01). The mean value of the lowest partial pressure of oxygen in the hypoxemia group was significantly lower than that in the non-hypoxemia group (P 0.01). 3. Postoperative situation: The indexes of the two groups were analyzed during the hospital, and the patients in the hypoxemia group were breathed out. The duration of ventilation was significantly longer in the hypoxemia group than in the non-hypoxemia group (P 0.05). The hypoxemia group was (49.53 +21.71) h, and the non-hypoxemia group was (25.71 +20.83) H. The incidence of postoperative hypoxemia (PaO 2/FiO 2 < 200 mmHg) in the hypoxemia group, the ICU retention time and the postoperative hospitalization time were significantly longer than those in the non-hypoxemia group (P 0.05). Conclusion: Hypoxemia is a common complication of aortic dissection. Many patients with aortic dissection complicate with hypoxemia before operation. Hypoxemia can affect the function of organs in the whole body. Preoperative, intraoperative and postoperative impacts on the body function, resulting in postoperative ventilator-assisted ventilation time, ICU stay time, postoperative hospital stay significantly prolonged, and significantly increased the incidence of intraoperative and postoperative hypoxemia, but there was no preoperative hypoxemia in patients with re-intubation rate, non-respiratory complications, mortality rate was significant. High condition.
【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R614
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本文編號：2193237