本文選題：Standford + A型主動(dòng)脈夾層�。� 參考：《新疆醫(yī)科大學(xué)》2015年碩士論文

【摘要】：目的：分析討論影響Standford A型主動(dòng)脈夾層住院患者圍手術(shù)期死亡的相關(guān)危險(xiǎn)因素。方法：回顧性收集、分析新疆醫(yī)科大學(xué)第一附屬醫(yī)院心臟外科2006年1月至2014年12月收治的127例Standford A型主動(dòng)脈夾層患者為研究對(duì)象,其中,生存組109例,死亡組18例,其中男性91例,女性36例,年齡(61.9±13.6)歲。比較分析兩組患者術(shù)后轉(zhuǎn)歸的年齡,性別,是否合并糖尿病、高尿酸血癥、腎功能不全等既往史,心包填塞的存在與否等臨床癥狀、體征,以及高血壓知曉情況,吸煙、飲酒史等可能相關(guān)因素,采用多因素logistic回歸分析篩選主動(dòng)脈夾術(shù)后急性期的危險(xiǎn)因素。結(jié)果：127例Standford A型主動(dòng)脈夾層患者圍手術(shù)期總死亡18例,死亡率為14.17%；經(jīng)單、多因素logistic回歸分析：高齡患者(年齡大于60歲)、吸煙使、高血壓病史、術(shù)前左心功能較差(LVEF小于50%),腎功能不全(血肌酐大于130pmol/L)、存在心包積液、體外循環(huán)時(shí)間大于180 min以及主動(dòng)脈阻斷時(shí)間大于120 min與術(shù)后圍手術(shù)期死亡有顯著關(guān)系,腎功能不全(血肌酐大于130pmol/L)患者5例,死亡3例P值為0.001,多因素回歸分析結(jié)果：回歸系數(shù)為3.918,標(biāo)準(zhǔn)誤為1.407,95%CI：1.159-6.676。P值為0.005。結(jié)論：高齡患者(年齡大于60歲)、吸煙使、高血壓病史、術(shù)前左心功能較差(LVEF小于50%),腎功能不全(血肌酐大于130pmol/L)、存在心包積液、體外循環(huán)時(shí)間大于180 min以及主動(dòng)脈阻斷時(shí)間大于120 min與術(shù)后早期死亡有顯著關(guān)系,其中腎功能不全(血肌酥"g130pmol/L)是術(shù)后早期死亡的獨(dú)立危險(xiǎn)因素包填塞,伴發(fā)上述病變可使Standford A型主動(dòng)脈夾層患者發(fā)生急性期死亡的危險(xiǎn)明顯升高,應(yīng)積極進(jìn)行血管活性藥物的保護(hù)性降壓控制,進(jìn)行緊急手術(shù)或大血管腔內(nèi)介入治療等應(yīng)對(duì)措施。
[Abstract]:Objective: to analyze the risk factors of perioperative death in inpatients with Standford A aortic dissection. Methods: a retrospective study was conducted on 127 patients with Standford A aortic dissection admitted from January 2006 to December 2014 in Cardiac surgery, the first affiliated Hospital of Xinjiang Medical University, including 109 patients in survival group and 18 patients in death group. There were 91 males and 36 females aged 61.9 鹵13.6 years. The age, sex, diabetes mellitus, hyperuricemia, renal insufficiency and other clinical symptoms, signs, hypertension and smoking were compared between the two groups, including age, sex, diabetes mellitus, hyperuricemia, renal insufficiency, and the presence or absence of pericardial tamponade. The risk factors of acute stage after aortic clamp operation were screened by multivariate logistic regression analysis. Results among 127 patients with Standford A aortic dissection, 18 died during perioperative period, the mortality rate was 14.17.The single, multivariate logistic regression analysis showed that the elderly patients (age > 60 years, smoking, hypertension history), Preoperative left ventricular dysfunction (LVEF < 50), renal insufficiency (serum creatinine > 130 mmol / L, pericardial effusion, cardiopulmonary bypass time > 180 min and aortic occlusion time > 120 min) were significantly associated with perioperative mortality. There were 5 cases of renal insufficiency (serum creatinine > 130 mmol / L) and 3 cases of death (P = 0.001). The regression coefficient was 3.918 and the standard error was 1.407 CI: 1.159-6.676.P was 0.005. Conclusion: elderly patients (age > 60 years old, smoking, history of hypertension, poor left ventricular function before operation, LVEF < 50), renal insufficiency (serum creatinine > 130 pmol / L), pericardial effusion, pericardial effusion. Cardiopulmonary bypass time was more than 180 min and aortic occlusion time was more than 120 min. Renal insufficiency (g130 pmol / L) was an independent risk factor for early postoperative death. The risk of acute death in patients with Standford A aortic dissection can be significantly increased by the above pathological changes. The protective hypotension control of vasoactive drugs and emergency operation or endovascular intervention should be actively carried out in patients with Standford A aortic dissection.
【學(xué)位授予單位】：新疆醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R654.2
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本文編號(hào)：1813680