Severe hypoxemia after Stanford A aortic dissection surgery: a clinical analysis of 162 cases

Zhipeng HAO; Yong WANG; Yu ZHU; Hailong WANG; Lingchao LIU; Yingbin XIAO

doi:10.16016/j.1000-5404.202001031

您当前的位置：

首页 >

文章列表页 >

Severe hypoxemia after Stanford A aortic dissection surgery: a clinical analysis of 162 cases

Clinical Medicine | 更新时间：2026-01-09

- Severe hypoxemia after Stanford A aortic dissection surgery: a clinical analysis of 162 cases
- Journal of Third Military Medical University Vol. 42, Issue 9, Pages: 929-936(2020)
- 作者机构：
  
  400037 重庆，陆军军医大学(第三军医大学)第二附属医院全军心血管外科研究所
- 作者简介：
- 基金信息：
- DOI：10.16016/j.1000-5404.202001031
  CLC： R619;R654.3;R845.22
- Received：05 January 2020，
  
  Revised：2020-03-06，
  
  Published：15 May 2020
- 稿件说明：
移动端阅览
Zhipeng HAO, Yong WANG, Yu ZHU, et al. Severe hypoxemia after Stanford A aortic dissection surgery: a clinical analysis of 162 cases[J]. Journal of Third Military Medical University, 2020, 42(9): 929-936.
DOI：

Zhipeng HAO, Yong WANG, Yu ZHU, et al. Severe hypoxemia after Stanford A aortic dissection surgery: a clinical analysis of 162 cases[J]. Journal of Third Military Medical University, 2020, 42(9): 929-936. DOI： 10.16016/j.1000-5404.202001031.

摘要

目的

对Stanford A型主动脉夹层进行临床分析，探讨手术后重度低氧血症的危险因素。

方法

纳入2016年1月至2019年3月期间162例Stanford A型主动脉夹层并接受住院手术治疗的患者进行回顾性分析。患者术后72 h内氧合指数(PaO

/FiO

)≤100 mmHg为重度低氧组，PaO

/FiO

100 mmHg为非重度低氧血症组。比较两组患者围术期临床指标，并分析重度低氧血症相关危险因素。

结果

患者术后重度低氧血症发生率50.6%(82/162)，重度低氧血症患者机械通气时间、术后ICU时间和术后住院时间较非重度低氧血症组患者显著延长(

0.05)。术后早期死亡率11.7%(19/162)，重度低氧血症组17.1%(14/82)显著高于非重度低氧血症组6.1%(5/80)(

=0.032)；多因素回归分析显示，BMI

24 kg/m

，术前PaO

/FiO

≤300 mmHg和体外循环(cardiopulmonary bypass

CPB)时间

195 min为术后重度低氧血症的独立危险因素。

结论

BMI

24 kg/m

、术前PaO

/FiO

≤300 mmHg、CPB时间

195 min是Stanford A型主动脉夹层术后重度低氧血症的独立危险因素。

Abstract

Objective

To investigate the risk factors for post-operative severe hypoxemia in patients with Stanford A aortic dissection.

Methods

Clinical data of 162 patients with Stanford A aortic dissection undergoing surgical treatment in our hospital from January 2016 to March 2019 were collected and retrospectively analyzed in this study. According to their oxygenation index(PaO

/FiO

) within 72 h after operation

they were divided into severe hypoxia group (≤100 mmHg) and non-severe hypoxemia group(

100 mmHg). The perioperative clinical indexes were compared between the 2 groups

and the risk factors of severe hypoxemia were analyzed.

Results

The incidence of severe hypoxemia was 50.6%(82/162) in the cohort. The severe hypoxia group had significantly longer time of mechanical ventilation

postoperative length of ICU stay and hospital stay when compared with the non-severe hypoxia group(all

0.05). The total mortality rate was 11.7%(19/162)

with that in the severe group obviously higher than that of the other group. Multivariate regression analysis showed that BMI

24 kg/m

(

=2.604

95%

: 1.055~6.427

=0.038)

preoperative PaO

/FiO

≤300 mmHg(

=2.963

95%

: 1.283~6.841

=0.011) and cardiopulmonary bypass(CPB) time

195 min(

=1.007

95%

: 1.000~1.014

0.044) were independent risk factors for post-operative severe hypoxemia after surgery.

Conclusion

BMI

24 kg/m

preoperative PaO

/FiO

≤300 mmHg and CPB time

195 min are independent risk factors for post-operative severe hypoxemia after surgery of Stanford type A aortic dissection.

关键词

Keywords

references

MUSSA F F, HORTON J D, MORIDZADEH R, et al . Acute aortic dissection and intramural hematoma[J ] . JAMA, 2016, 316(7): 754. DOI:10.1001/jama.2016.10026.

ERBEL R, ABOYANS V, BOILEAU C, et al . Corrigendum to: 2014 ESC Guidelines on the diagnosis and treatment of aortic diseases[J ] . Eur Heart J, 2015, 36(41): 2779. DOI:10.1093/eurheartj/ehv178.

BOSSONE E, LABOUNTY T M, EAGLE K A. Acute aortic syndromes: diagnosis and management, an update[J]. Eur Heart J, 2018, 39(9): 739-749. DOI:10.1093/eurheartj/ehx319.

GONG M, WU Z N, XU S J, et al . Increased risk for the development of postoperative severe hypoxemia in obese women with acute type a aortic dissection[J ] . JCardiothorac Surg, 2019, 14(1): 81. DOI:10.1186/s13019-019-0888-9.

ARDS DEFINITION TASK FORCE, RANIERI V M, RUBENFELD G D, et al . Acute respiratory distress syndrome: the Berlin Definition[J ] . JAMA, 2012, 307(23): 2526-2533. DOI:10.1001/jama.2012.5669.

LIU N, ZHANG W, MA W G, et al . Risk factors for hypoxemia following surgical repair of acute type A aortic dissection[J ] . Interact Cardiovasc Thorac Surg, 2017, 24(2): 251-256. DOI:10.1093/icvts/ivw272.

HIRATZKA L F, BAKRIS G L, BECKMAN J A, et al . 2010 ACCF/Aha/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM guidelines for the diagnosis and management of patients with thoracic aortic disease. A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, American Association for Thoracic Surgery, American College ofRadiology, American Stroke Association, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of Thoracic Surgeons, and Society for Vascular Medicine[J ] . J Am Coll Cardiol, 2010, 55(14): e27-e129. DOI:10.1016/j.jacc.2010.02.015.

DOS SANTOS N P, MITSUNAGA R M, BORGES D L, et al . Factors associated to hypoxemia in patients undergoing coronary artery bypass grafting[J ] . Revista Brasileira De Cirurgia Cardiovasc, 2013, 28(3): 364-370. DOI:10.5935/1678-9741.20130056.

HOWARD D P, BANERJEE A, FAIRHEAD J F, et al . Population-based study of incidence and outcome of acute aortic dissection and premorbid risk factor control: 10-year results from the Oxford Vascular Study[J ] . Circulation, 2013, 127(20): 2031-2037. DOI:10.1161/CIRCULATIONAHA.112.000483.

SHENG W, YANG H Q, CHI Y F, et al . Independent risk factors for hypoxemia after surgery for acute aortic dissection[J ] . Saudi Med J, 2015, 36(8): 940-946. DOI:10.15537/smj.2015.8.11583.

SHI S, GAO Y, WANG L M, et al . Elevated free fatty acid level is a risk factor for early postoperative hypoxemia after on-pump coronary artery bypass grafting: association with endothelial activation[J ] . J Cardiothorac Surg, 2015, 10: 122. DOI:10.1186/s13019-015-0323-9.

ALAM M, BANDEALI S J, KAYANI W T, et al . Comparison by meta-analysis of mortality after isolated coronary artery bypass grafting in women versus men[J ] . Am J Cardiol, 2013, 112(3): 309-317. DOI:10.1016/j.amjcard.2013.03.034.

NASHEF S A M, ROQUES F, SHARPLES L D, et al . EuroSCORE Ⅱ[J ] . Eur J Cardio-Thorac Surg, 2012, 41(4): 734-745. DOI:10.1093/ejcts/ezs043.

WANG Y H, XUE S, ZHU H S. Risk factors for postoperative hypoxemia in patients undergoing Stanford A aortic dissection surgery[J]. J Cardiothorac Surg, 2013, 8: 118. DOI:10.1186/1749-8090-8-118.

LIO A, BOVIO E, NICOL F, et al . Influence of body mass index on outcomes of patients undergoing surgery for acute aortic dissection: a propensity-matched analysis[J ] . Tex Heart Inst J, 2019, 46(1): 7-13. DOI:10.14503/THIJ-17-6365.

JOSEPH P G, PARE G, ANAND S S. Exploring gene-environment relationships in cardiovascular disease[J]. Can J Cardiol, 2013, 29(1): 37-45. DOI:10.1016/j.cjca.2012.10.009.

GREGOR M F, HOTAMISLIGIL G S. Inflammatory mechanisms in obesity[J]. Annu Rev Immunol, 2011, 29(1): 415-445. DOI:10.1146/annurev-immunol-031210-101322.

MCCALLISTER J W, ADKINS E J, O'BRIEN J M Jr. Obesity and acute lung injury[J]. Clin Chest Med, 2009, 30(3): 495-508, viii. DOI:10.1016/j.ccm.2009.05.008.

MEMTSOUDIS S G, BOMBARDIERI A M, MA Y, et al . Mortality of patients with respiratory insufficiency and adult respiratory distress syndrome after surgery: the obesity paradox[J ] . J Intensive Care Med, 2012, 27(5): 306-311. DOI:10.1177/0885066611411410.

FERNANDEZ-BUSTAMANTE A, REPINE J. Chronic inflammatory diseases and the acute respiratory distress syndrome(ARDS)[J]. Curr Pharm Des, 2014, 20(9): 1400-1408. DOI:10.2174/13816128113199990561.

STAPLETON R D, SURATT B T. Obesity and nutrition in acute respiratory distress syndrome[J]. Clin Chest Med, 2014, 35(4): 655-671. DOI:10.1016/j.ccm.2014.08.005.

DUAN X Z, XU Z Y, LU F L, et al . Inflammation is related to preoperative hypoxemia in patients with acute Stanford type A aortic dissection[J ] . J Thorac Dis, 2018, 10(3): 1628-1634. DOI:10.21037/jtd.2018.03.48.

ZHAO G D, ZHU Y, YU D N, et al . The effect of ulinastatin on hyperglycemia in patients undergoing hepatectomy[J ] . J Surg Res, 2015, 193(1): 223-228. DOI:10.1016/j.jss.2014.08.027.

WEN D, DU X, DONG J Z, et al . Value of D-dimer and C reactive protein in predicting inhospital death in acute aortic dissection[J ] . Heart, 2013, 99(16): 1192-1197. DOI:10.1136/heartjnl-2013-304158.

RAJA S G, DREYFUS G D. Modulation of systemic inflammatory response after cardiac surgery[J]. Asian Cardiovasc Thorac Ann, 2005, 13(4): 382-395. DOI:10.1177/021849230501300422.

SZÉKELY A, CSERÉP Z, SÁPI E, et al . Risks and predictors of blood transfusion in pediatric patients undergoing open heart operations[J ] . Ann Thorac Surg, 2009, 87(1): 187-197. DOI:10.1016/j.athoracsur.2008.09.079.

Views

下载量

CSCD

Alert me when the article has been cited

提交

Tools

Publicity Resources

Risk factors for stroke-associated pneumonia after endovasular treatment in acute anterior circulation ischemic stroke patients

Impact of molecular heterogeneity of NPM1 mutations on prognosis of acute myeloid leukemia: a clinical report of 86 cases

Efficacy and prognostic factors of second transurethral resection for non-muscle-invasive bladder cancer

Incidence and risk factors of acute renal injury after Stanford type A aortic dissections

Predictive value and risk factors of embryo implantation site for placenta previa

Related Author

CAI Zhengwei

ZHANG Xiaoge

GAO Yang

ZUO Meng

DAI Lin

QIN Yujie

WANG Yu

YU Xiaoda

Related Institution

Department of Neurology， First Affiliated Hospital， Army Medical University （Third Military Medical University）

Chongqing Center for Disease Control and Prevention

the First Clinical Medical College of Lanzhou University, the First Hospital of Lanzhou University

Department of Hematology, the First Hospital of Lanzhou University

Department of Urology， Army Medical Center of PLA/Daping Hospital of Third Military Medical University

⁰