急性Standford A 型主动脉夹层围手术期患者 发生低血氧症的危险因素及其预测价值

Hypoxemia in acute Stanford type A aortic dissection: analysis of risk factors and prediction value

摘要:

目的 探讨急性Stanford A 型主动脉夹层患者手术前后低氧血症的相关危险因素及其预测价值。 方法 选取2014 年9 月—2017 年10 月河南省胸科医院收治的急性Stanford A 型主动脉夹层患者128 例。根 据是否存在术前低氧血症将研究对象分为术前低氧血症组和术前非低氧血症组；根据是否存在术后低氧血 症将患者分为术后低氧血症组和术后非低氧血症组。采用回顾性分析的方法，收集患者一般资料及术前动脉 血氧饱和度、术后24 h 内氧合指数及血红蛋白浓度等临床资料。分析患者的临床资料与低氧血症的关系。 结果 术前低氧血症组和术前非低氧血症组患者术后24 h 内患者氧合指数、体重指数、慢性阻塞性肺疾病史 及术前超敏C 反应蛋白比较，差异有统计学意义（P <0.05）。术后低氧血症组和术后非低氧血症组患者慢性 阻塞性肺疾病史、术中输血总量、术中体外循环转流时间及术后24 h 内患者氧合指数比较，差异有统计学意 义（P <0.05）。多因素Logistic 回归分析显示，体重指数[Ol ^ R=1.306（95% CI ：1.038，1.643），P =0.024]、慢 性阻塞性肺疾病史[Ol ^ R=1.278（95% CI ：1.024，1.594），P =0.043] 及超敏C 反应蛋白[Ol ^ R=1.257（95% CI ： 1.116，1.417），P =0.039] 是影响术前低氧血症的独立危险因素，术中输血总量[Ol ^ R=1.322（95% CI ：1.068， 1.637），P =0.008]、术中体外循环转流时间[Ol ^ R=1.458（95% CI ：1.208，1.760），P =0.029] 是影响术后低氧血 症的独立危险因素。结论 超敏C 反应蛋白对于术前低氧血症发生有预测价值，而术中输血量、术中体外循 环转流时间对于术后低氧血症的发生具有较好的预测价值。

Abstract:

Objective To investigate the risk and prediction factors of hypoxemia before and after treatment of acute Stanford A aortic dissection. Methods Totally 128 patients with acute Stanford A aortic dissection treated in our hospital from September 2014 to October 2017 were included. The subjects were divided into preoperative hypoxemia group and preoperative non-hypoxemia group according to the presence of preoperative hypoxemia; the patients were divided into postoperative hypoxemia group and postoperative non-hypoxemia group according to the presence of postoperative hypoxemia. The general data, preoperative arterial oxygen saturation, postoperative oxygenation index and hemoglobin concentration were collected by retrospective analysis. The relationship between clinical data and hypoxemia was analyzed. Results The preoperative hypoxemia group and non-hypoxemia group had statistically significant differences in oxygenation index with 24h after operation, body mass index, chronic obstructive pulmonary history and preoperational hypersensitive C-reactive protein (P < 0.05). There are statistically significant differences in history of chronic obstructive pulmonary disease, intraoperative blood transfusion, intraoperative circulating flow time in vitro and postoperative oxygenation index between postoperative hypoxemia group and postoperative non-hypoxemia group (P < 0.05). Multivariate logistic regression analysis showed that body mass index [Ol^R=1.306 (95% CI: 1.038, 1.643), P = 0.024], history of chronic obstructive pulmonary disease [Ol^R=1.278 (95% CI: 1.024, 1.594), P = 0.043] and hypersensitive C-reactive protein [Ol^R=1.257 (95% CI: 1.116, 1.417), P = 0.039] were independent risk factors for preoperative hypoxemia; total intraoperative blood transfusion [Ol^R=1.322 (95% CI: 1.068, 1.637), P = 0.039] and time of intraoperative extraoperative circulation [Ol^R=1.458 (95% CI: 1.208, 1.760), P = 0.029] were independent risk factors for postoperative hypoxemia. Conclusions Hypersensitive C-reactive protein has a good value in predicting the occurrence of hypoxemia before operation; the amount of blood transfused during operation and the time of intraoperative extraoperative circulation have a good value in predicting the occurrence of hypoxemia after operation.