急性Stanford A型主動(dòng)脈夾層圍手術(shù)期低氧血癥危險(xiǎn)因素分析
發(fā)布時(shí)間：2018-08-02 21:31
【摘要】：目的本研究目的在探討急性Stanford A型主動(dòng)脈夾層患者發(fā)生術(shù)前低氧血癥及術(shù)后低氧血癥相關(guān)危險(xiǎn)因素。方法回顧性研究分析南京鼓樓醫(yī)院心胸外科自2013年1月份至2014年1月份急診入院急性Stanford A型主動(dòng)脈夾層患者的年齡、性別、體重指數(shù)(body mass index,BMI)、高血壓病史、吸煙史等基本資料信息及患者術(shù)前動(dòng)脈氧飽和度、術(shù)后24小時(shí)內(nèi)患者氧合指數(shù)(PaO2/FiO2)、術(shù)前白細(xì)胞計(jì)數(shù)、術(shù)前中性粒細(xì)胞百分比、術(shù)前血紅蛋白濃度、術(shù)前凝血酶原時(shí)間、術(shù)前C反應(yīng)蛋白水平、術(shù)前乳酸水平、術(shù)后24小時(shí)內(nèi)患者血紅蛋白濃度、體外循環(huán)轉(zhuǎn)流時(shí)間、術(shù)中深低溫停循環(huán)時(shí)間、術(shù)中最低直腸溫度、術(shù)中輸血總量等臨床資料。術(shù)前及術(shù)后的低氧血癥皆定義為：氧合指數(shù)低于300 (Pa02/Fi02300)。采用t檢驗(yàn)、卡方檢驗(yàn)、Mann-Whitney U檢驗(yàn)、單因素分析、多因素Logistic回歸及ROC曲線分析患者的一般情況及相關(guān)實(shí)驗(yàn)室檢查資料和術(shù)中相關(guān)資料與低氧血癥的關(guān)系。結(jié)果本研究排除資料不全的患者,共入組急性Stanford A型患者45例。入選的患者中男性有37例(82%),女性有8例(18%),平均年齡在49.6±13.0歲,男性、女性患者的平均年齡無明顯差別(49.05±12.2歲VS52.1±16.7歲,P0.05)。所有患者的平均體重指數(shù)為25.3±2.7(kg／m2)。所有患者中高血壓病患者有31例(69%)；有吸煙史的患者有13例(29%)。所有患者的術(shù)前平均氧合指數(shù)為284.6±91.1,其中有24例(53.3%)的患者發(fā)生術(shù)前低氧血癥,術(shù)前低氧血癥組的術(shù)前氧合指數(shù)為220.1±61.7,術(shù)前非低氧血癥組患者的術(shù)前平均氧合指數(shù)為358.2±56.7,(P0.05)。所有患者的術(shù)前白細(xì)胞計(jì)數(shù)平均為10.1±3.210^9/L,術(shù)前中性粒細(xì)胞百分比平均80.4±10.7%,術(shù)前C反應(yīng)蛋白水平平均為11.6±9.4mg/L,術(shù)前血紅蛋白濃度的中位數(shù)為125g/L,術(shù)前凝血酶原時(shí)間平均13.6±2.3s,術(shù)前乳酸水平平均2.3±2.5mmol/L。患者術(shù)后平均氧合指數(shù)為209.2±87.1,其中38例(84%)的患者發(fā)生術(shù)后低氧血癥,術(shù)后低氧血癥組患者的術(shù)后氧合指數(shù)為182.3±63.9,術(shù)后非低氧組患者的術(shù)后氧合指數(shù)為355.1±31.5,(P0.05)�；颊咝g(shù)后血紅蛋白濃度平均11.1±2.2g/L,體外循環(huán)轉(zhuǎn)流時(shí)間平均253.4±74.3min,深低溫停循環(huán)時(shí)間平均30±8.6min,術(shù)中最低直腸溫平均19.7±2.8℃,術(shù)中輸血量中位數(shù)在2800ml。多因素Logistic回歸分析急性Stanford A型主動(dòng)脈夾層術(shù)前低氧血癥危險(xiǎn)因素為術(shù)前C反應(yīng)蛋白水平(OR:1.176,95%CI:1.025-1.348)。多因素Logistic回歸分析急性Stanford A型主動(dòng)脈夾層術(shù)后低氧血癥危險(xiǎn)因素為術(shù)中輸血量(OR:1.005,95%CI:1.001-1.010)。結(jié)論1、急性Stanford A型主動(dòng)脈夾層患者圍手術(shù)期低氧血癥發(fā)生率較高,是一種常見的并發(fā)癥。2、急性Stanford A型主動(dòng)脈夾層患者術(shù)前低氧血癥的獨(dú)立危險(xiǎn)因素為術(shù)前C反應(yīng)蛋白水平。3、急性Stanford A型主動(dòng)脈夾層患者術(shù)后低氧血癥的獨(dú)立危險(xiǎn)因素為術(shù)中輸血量。4、急性Stanford A型主動(dòng)脈夾層患者術(shù)前氧合指數(shù)與體重指數(shù)存在一定相關(guān)性。5、急性Stanford A型主動(dòng)脈夾層患者術(shù)后低氧血癥與術(shù)前氧合指數(shù)存在一定相關(guān)性。
[Abstract]:Objective the purpose of this study was to investigate the risk factors associated with preoperative hypoxemia and postoperative hypoxemia in patients with acute Stanford A aortic dissection. Methods a retrospective study was conducted to analyze the age, sex, and body of patients with acute Stanford A aortic dissection from January 2013 to January 2014 of Nanjing Gulou Hospital. The body mass index (BMI), the history of hypertension, the history of smoking, the preoperative arterial oxygen saturation, the oxygenation index (PaO2/FiO2), the preoperative leucocyte count, the preoperative neutrophils percentage, preoperative hemoglobin concentration, preoperation hemoglobin concentration, preoperation time of prothrombin, preoperative C reactive protein and preoperative lactate Hemoglobin concentration, cardiopulmonary bypass time, deep hypothermia cycle time, minimum rectal temperature, intraoperative blood transfusion, preoperative and postoperative hypoxemia were defined as: oxygen index was lower than 300 (Pa02/ Fi02300). T test, chi square test, and Mann-Whitney U test were used. Factor analysis, multiple factor Logistic regression and ROC curve analysis of patients' general situation, related laboratory examination data and the relationship between intraoperative data and hypoxemia. Results 45 cases of acute Stanford A patients were enrolled in this study. There were 37 cases (82%) and 8 women (18%) in women. The average age of men and women was 49.6 + 13 years old (49.05 + 12.2 years VS52.1 + 16.7 years, P0.05). The average body mass index of all patients was 25.3 + 2.7 (kg / m2). There were 31 patients (69%) in all patients with hypertension and 13 patients (29%) with the history of smoking. The average preoperative oxygenation index of all patients was 284.6 + 9. 1.1, 24 cases (53.3%) had preoperative hypoxemia, the preoperative hypoxemia group was 220.1 + 61.7 and the preoperative average oxygenation index was 358.2 + 56.7 (P0.05). The average number of preoperative leukocyte counts in all patients was 10.1 + 3.210^9/L, and the average percentage of neutrophils before operation was 80.4 +. 10.7%, the average level of C reactive protein was 11.6 + 9.4mg/L before operation, the median of pre operation hemoglobin concentration was 125g/L, the preoperation prothrombin time was 13.6 + 2.3S, the average preoperative lactic acid level was 209.2 + 87.1 after operation, and 38 patients (84%) had postoperative hypoxemia, and postoperative hypoxemia group suffered from hypoxemia. The postoperative oxygenation index was 182.3 + 63.9, and the postoperative oxygenation index was 355.1 + 31.5 (P0.05). The average hemoglobin concentration was 11.1 + 2.2g/L, cardiopulmonary bypass time averaged 253.4 74.3min, deep hypothermia cycle time averaged 30 + 8.6min, and the minimum rectal temperature was 19.7 + 2.8 C during the operation, and the amount of blood transfusion during the operation. The median risk factor for acute Stanford A type aortic dissection preoperation hypoxemia was the preoperative C reactive protein level (OR:1.176,95%CI:1.025-1.348) in the 2800ml. multiple factor Logistic regression analysis. The risk factors for hypoxemia after acute Stanford A aortic dissection were intraoperative blood transfusion (OR:1.005,95%CI:1.0) by multiple factor Logistic regression (OR:1.005,95%CI:1.0). 01-1.010) conclusion 1. The incidence of perioperative hypoxemia in patients with acute Stanford A aortic dissection is high and is a common complication of.2. The independent risk factor for preoperative hypoxemia in patients with acute Stanford A aortic dissection is the preoperative C reaction protein level.3, and postoperative hypoxemia in patients with acute Stanford A type aortic dissection. The independent risk factor was intraoperative blood transfusion.4. There was a certain correlation between preoperative oxygen index and body mass index (.5) in patients with acute Stanford A type aortic dissection. There was a certain correlation between postoperative hypoxemia and preoperative oxygenation index in patients with acute Stanford A type aortic dissection.
【學(xué)位授予單位】：東南大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R654.2
[Abstract]:Objective the purpose of this study was to investigate the risk factors associated with preoperative hypoxemia and postoperative hypoxemia in patients with acute Stanford A aortic dissection. Methods a retrospective study was conducted to analyze the age, sex, and body of patients with acute Stanford A aortic dissection from January 2013 to January 2014 of Nanjing Gulou Hospital. The body mass index (BMI), the history of hypertension, the history of smoking, the preoperative arterial oxygen saturation, the oxygenation index (PaO2/FiO2), the preoperative leucocyte count, the preoperative neutrophils percentage, preoperative hemoglobin concentration, preoperation hemoglobin concentration, preoperation time of prothrombin, preoperative C reactive protein and preoperative lactate Hemoglobin concentration, cardiopulmonary bypass time, deep hypothermia cycle time, minimum rectal temperature, intraoperative blood transfusion, preoperative and postoperative hypoxemia were defined as: oxygen index was lower than 300 (Pa02/ Fi02300). T test, chi square test, and Mann-Whitney U test were used. Factor analysis, multiple factor Logistic regression and ROC curve analysis of patients' general situation, related laboratory examination data and the relationship between intraoperative data and hypoxemia. Results 45 cases of acute Stanford A patients were enrolled in this study. There were 37 cases (82%) and 8 women (18%) in women. The average age of men and women was 49.6 + 13 years old (49.05 + 12.2 years VS52.1 + 16.7 years, P0.05). The average body mass index of all patients was 25.3 + 2.7 (kg / m2). There were 31 patients (69%) in all patients with hypertension and 13 patients (29%) with the history of smoking. The average preoperative oxygenation index of all patients was 284.6 + 9. 1.1, 24 cases (53.3%) had preoperative hypoxemia, the preoperative hypoxemia group was 220.1 + 61.7 and the preoperative average oxygenation index was 358.2 + 56.7 (P0.05). The average number of preoperative leukocyte counts in all patients was 10.1 + 3.210^9/L, and the average percentage of neutrophils before operation was 80.4 +. 10.7%, the average level of C reactive protein was 11.6 + 9.4mg/L before operation, the median of pre operation hemoglobin concentration was 125g/L, the preoperation prothrombin time was 13.6 + 2.3S, the average preoperative lactic acid level was 209.2 + 87.1 after operation, and 38 patients (84%) had postoperative hypoxemia, and postoperative hypoxemia group suffered from hypoxemia. The postoperative oxygenation index was 182.3 + 63.9, and the postoperative oxygenation index was 355.1 + 31.5 (P0.05). The average hemoglobin concentration was 11.1 + 2.2g/L, cardiopulmonary bypass time averaged 253.4 74.3min, deep hypothermia cycle time averaged 30 + 8.6min, and the minimum rectal temperature was 19.7 + 2.8 C during the operation, and the amount of blood transfusion during the operation. The median risk factor for acute Stanford A type aortic dissection preoperation hypoxemia was the preoperative C reactive protein level (OR:1.176,95%CI:1.025-1.348) in the 2800ml. multiple factor Logistic regression analysis. The risk factors for hypoxemia after acute Stanford A aortic dissection were intraoperative blood transfusion (OR:1.005,95%CI:1.0) by multiple factor Logistic regression (OR:1.005,95%CI:1.0). 01-1.010) conclusion 1. The incidence of perioperative hypoxemia in patients with acute Stanford A aortic dissection is high and is a common complication of.2. The independent risk factor for preoperative hypoxemia in patients with acute Stanford A aortic dissection is the preoperative C reaction protein level.3, and postoperative hypoxemia in patients with acute Stanford A type aortic dissection. The independent risk factor was intraoperative blood transfusion.4. There was a certain correlation between preoperative oxygen index and body mass index (.5) in patients with acute Stanford A type aortic dissection. There was a certain correlation between postoperative hypoxemia and preoperative oxygenation index in patients with acute Stanford A type aortic dissection.
【學(xué)位授予單位】：東南大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R654.2
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