本文選題：胸部主動(dòng)脈 + 血管置換��； 參考：《寧夏醫(yī)科大學(xué)》2015年碩士論文

【摘要】：目的本研究通過(guò)觀察我科107例胸部主動(dòng)脈血管疾病的患者的手術(shù)治療效果,收集臨床資料,進(jìn)行回顧性研究,分析接受外科手術(shù)治療的胸部主動(dòng)脈血管疾病的患者圍術(shù)期的危險(xiǎn)因素,總結(jié)并歸納,以期為臨床未來(lái)的治療起到一定的參考作用。方法1.篩選2005年1月至2014年6月期間于寧夏醫(yī)科大學(xué)總醫(yī)院心臟中心大血管外科的胸部主動(dòng)脈疾病的患者(包括升主動(dòng)脈瘤、馬凡綜合癥、Stanford A型主動(dòng)脈夾層等)的臨床資料共107例為研究總體進(jìn)行回顧性分析。2.收集我科接受手術(shù)治療的胸主動(dòng)脈疾病患者的臨床資料,分為兩大組:未涉及主動(dòng)脈弓部手術(shù)組:年齡、性別、心功能NYHA分級(jí)、高血壓病史、冠心病病史、吸煙史、主動(dòng)脈直徑、術(shù)前EF值、手術(shù)時(shí)間、CPB時(shí)間、ACC時(shí)間、同期手術(shù)、術(shù)后氣管插管輔助呼吸時(shí)間、術(shù)后12小時(shí)引流量、術(shù)后ICU停留時(shí)間;涉及主動(dòng)脈弓部手術(shù)組:年齡、性別、高血壓病史、吸煙史、手術(shù)期限、術(shù)前腎功能不全、手術(shù)時(shí)間、CPB時(shí)間、ACC時(shí)間、停循環(huán)時(shí)間、術(shù)后氣管插管輔助呼吸時(shí)間、術(shù)后ICU停留時(shí)間。3.使用SPSS 18.0對(duì)資料進(jìn)行單因素分析,然后采用Logistic回歸對(duì)與死亡相關(guān)的具有統(tǒng)計(jì)意義的單因素進(jìn)行多因素分析,篩選出具有統(tǒng)計(jì)意義的獨(dú)立危險(xiǎn)因素。4.對(duì)本研究中得出的結(jié)果進(jìn)行歸納總結(jié)。結(jié)果1.未涉及主動(dòng)脈弓部手術(shù)組共73例,死亡率是9.6%(7/73),與死亡相關(guān)的主要因素有:年齡大于60歲,吸煙,EF值50%,手術(shù)時(shí)間≥310min,ACC時(shí)間≥120min,CPB時(shí)間≥180min,術(shù)后12h引流量≥560ml,呼吸機(jī)輔助呼吸時(shí)間≥65小時(shí),監(jiān)護(hù)室停留時(shí)間≥90小時(shí)。涉及主動(dòng)脈弓部手術(shù)組共34例,死亡率是:26.5%(9/34),與死亡相關(guān)的主要因素有:性別,術(shù)前腎功能不全,急診手術(shù),CPB時(shí)間≥180min,ACC時(shí)間≥120min。2.采用Logistic回歸對(duì)單因素進(jìn)行多因素分析,未涉及主動(dòng)脈弓部手術(shù)組與死亡相關(guān)的獨(dú)立危險(xiǎn)因素為:CPB時(shí)間,呼吸機(jī)輔助時(shí)間;涉及主動(dòng)脈弓部手術(shù)組與死亡相關(guān)的獨(dú)立危險(xiǎn)因素為:術(shù)前腎功能不全,ACC時(shí)間。結(jié)論1.CPB時(shí)間≥180min及呼吸機(jī)輔助呼吸時(shí)間≥65h是未涉及主動(dòng)脈弓部的胸部主動(dòng)脈血管置換手術(shù)預(yù)測(cè)術(shù)后早期死亡的獨(dú)立危險(xiǎn)因素。2.術(shù)前腎功能不全及ACC時(shí)間≥120min是涉及主動(dòng)脈弓部的胸部主動(dòng)脈血管置換手術(shù)預(yù)測(cè)術(shù)后早期死亡的獨(dú)立危險(xiǎn)因素。3.本研究為單中心研究,樣本量較小,臨床數(shù)據(jù)存在部分缺失,對(duì)研究的最終結(jié)果可能會(huì)產(chǎn)生一定的影響,討論不夠全面,仍需長(zhǎng)期觀察并驗(yàn)證。
[Abstract]:Objective to study the clinical data of 107 patients with thoracic aortic vascular disease in our department. The perioperative risk factors of patients with thoracic aortic vascular diseases undergoing surgical treatment were analyzed, summarized and summarized in order to serve as a reference for future clinical treatment. Method 1. Screening of patients (including ascending aortic aneurysms) with thoracic aortic diseases (including ascending aortic aneurysms) from January 2005 to June 2014 in the Department of Cardiovascular surgery, Cardiac Center, General Hospital of Ningxia Medical University, The clinical data of 107 patients with Marfan's syndrome (Stanford A aortic dissection et al.) were analyzed retrospectively. The clinical data of patients with thoracic aortic disease undergoing surgical treatment were collected and divided into two groups: age, sex, NYHA classification of cardiac function, history of hypertension, history of coronary heart disease, and history of smoking. Aortic diameter, preoperative EF, CPB time and ACC time, simultaneous operation, tracheal intubation assisted respiration time, postoperative 12 hours drainage, postoperative ICU stay time, involved aortic arch operation group: age, sex, History of hypertension, history of smoking, duration of operation, preoperative renal insufficiency, CPB time, ACC time, circulatory arrest time, tracheal intubation assisted respiration time, postoperative ICU stay time. SPSS 18.0 was used for univariate analysis, and logistic regression was used for multivariate analysis of the statistical single factor associated with death. The independent risk factors with statistical significance were screened out. 4. The results of this study are summarized. Result 1. There were 73 cases in the group not involved in aortic arch surgery. The mortality rate was 9.67% of 73%. The main factors associated with death were: age over 60 years old. The EF value of smoking was 50%, the operation time 鈮，

本文編號(hào)：2032497