Stanford B型主动脉夹层患者TEVAR术后发生植入后综合征的危险因素

李高山; 潘文旭; 高智春; 尹纯; 胡美玲; 王颖; 晋军

doi:10.16016/j.2097-0927.202307091

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Stanford B型主动脉夹层患者TEVAR术后发生植入后综合征的危险因素

临床医学 | 更新时间：2026-01-09

- Stanford B型主动脉夹层患者TEVAR术后发生植入后综合征的危险因素
- Risk factors for TEVAR-related post-implantation syndrome in Stanford type B aortic dissection patients
- 陆军军医大学学报 2023年45卷第20期页码：2149-2158
- 作者机构：
  
  400037 重庆，陆军军医大学(第三军医大学)第二附属医院心血管内科
- 作者简介：
  
  [晋军，E-mail: jjxqyy@163.com JIN Jun, E-mail: jjxqyy@163.com
- 基金信息：
  
  成渝区域化心血管疾病防治综合体系关键技术研究及应用(KJZD-M202212802);重庆市研究生科研创新项目(CYB23283)
- DOI：10.16016/j.2097-0927.202307091
  中图分类号： R195.4;R543.105;R619
- 收稿：2023-07-25，
  
  修回：2023-08-18，
  
  纸质出版：2023-10-30
- 稿件说明：
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李高山, 潘文旭, 高智春, 等. Stanford B型主动脉夹层患者TEVAR术后发生植入后综合征的危险因素[J]. 陆军军医大学学报, 2023,45(20):2149-2158.

Gaoshan LI, Wenxu PAN, Zhichun GAO, et al. Risk factors for TEVAR-related post-implantation syndrome in Stanford type B aortic dissection patients[J]. Journal of Army Medical University, 2023, 45(20): 2149-2158.
李高山, 潘文旭, 高智春, 等. Stanford B型主动脉夹层患者TEVAR术后发生植入后综合征的危险因素[J]. 陆军军医大学学报, 2023,45(20):2149-2158. DOI： 10.16016/j.2097-0927.202307091.

Gaoshan LI, Wenxu PAN, Zhichun GAO, et al. Risk factors for TEVAR-related post-implantation syndrome in Stanford type B aortic dissection patients[J]. Journal of Army Medical University, 2023, 45(20): 2149-2158. DOI： 10.16016/j.2097-0927.202307091.

摘要

目的

探讨Stanford B型主动脉夹层(type B aortic dissection，TBAD)患者接受胸主动脉腔内修复术(thoracic endovascular aortic repair，TEVAR)后发生植入后综合征(post-implantation syndrome，PIS)的危险因素以及PIS与短期预后的关联。

方法

采用病例-对照研究设计方案，筛选2013年12月至2022年12月于我科接受TEVAR治疗TBAD患者的临床资料。根据患者术后是否发生PIS分为两组，探索影响PIS的独立相关因素。观察两组患者术后30天内全因死亡情况，绘制Kaplan-Meier生存曲线评估两组患者的术后30天生存情况，建立Logistic回归模型探索PIS与TEVAR术后30天全因死亡的关联。

结果

研究纳入373名TBAD患者，年龄(57.9±12.1)岁，其中男性289例(77.5%)。TEVAR术后发生PIS 106例(28.4%)。PIS组患者植入支架数量≥2个、手术时长≥2 h和植入聚对苯二甲酸乙二醇酯(polyethylene terephthalate

PET)覆膜材料支架的患者比例均显著高于非PIS组(

0.05)。多因素Logistic回归分析结果提示植入支架数≥2个(

=1.886

95%

：1.049~3.389

=0.034)、手术时长≥2 h(

=1.938

95%

：1.147~3.275

=0.013)和植入PET覆膜材料支架(

=2.131，95%

：1.263~3.597，

=0.005)是TEVAR术后发生PIS的独立危险因素。TEVAR术后30天内共发生死亡15例(4.0%)，其中PIS组10例(9.4%)，非PIS组5例(1.9%)。Kaplan-Meier曲线显示PIS组术后30天的生存曲线显著低于非PIS组(Log-rank

=0.000 7)。多因素Logistic回归模型显示胱抑素C(

=1.486，95%

：1.053~2.097，

=0.024)和PIS(

=5.628

95%

：1.836~17.248

=0.002)是TBAD患者TEAVR术后30天内死亡的独立危险因素。

结论

植入支架数≥2、手术时长≥2 h和植入PET覆膜材料支架与TEVAR术后发生PIS密切相关；而胱抑素C和术后发生PIS是TEVAR术后30天预后不良的重要危险因素。

Abstract

Objective

To investigate the risk factors associated with post-implantation syndrome (PIS) in Stanford type B aortic dissection (TBAD) patients undergoing thoracic endovascular aortic repair (TEVAR) and the relationship of PIS with short-term outcomes.

Methods

A case-control trial was conducted on the clinical data of patients undergoing TEVAR treatment for TBAD in our department from December 2013 to December 2022. They were divided into 2 groups based on the occurrence of PIS. Independent risk factors were analyzed according to the different clinical characteristics between the 2 groups. The overall 30-day mortality following TEVAR was assessed in both groups. Kaplan-Meier survival curves were utilized to evaluate the 30-day postoperative survival. Logistic regression models were constructed to investigate the relationship between PIS and overall mortality occurring within 30 d after TEVAR.

Results

A total of 373 TBAD patients

with an average age of 57.9±12.1 years and a male ratio of 77.5% (289 cases)

were enrolled in this study. There were 106 cases (28.4%) experiencing PIS following TEVAR. Significantly larger proportions of implanted stents ≥2

operation duration ≥2 h and implantation of polyethylene terephthalate (PET)-coverted stents were observed in the PIS group than the non-PIS group (

0.05). Multivariate logistic regression analysis suggested that implanted stents ≥2 (

=1.886

95%

: 1.049~3.389

=0.034)

operation duration ≥2 h (

=1.938

95%

: 1.147~3.275

=0.013) and implantation of PET-coverted stents (

=2.131

95%

: 1.263~3.597

=0.005) were independent risk factors for PIS after TEVAR. Within 30 d after TEVAR

15 (4.0%) cases dead

including 10 (9.4%) from the PIS group and 5 (1.9%) from the non-PIS group. Kaplan-Meier survival curve indicated a significantly lower survival in the PIS group (Log-rank

=0.000 7). The results of multivariate logistic regression model indicated that cystatin C (

=1.486

95%

: 1.053~2.097

=0.024) and PIS (

=5.628

95%

: 1.836~17.248

=0.002) were independent risk factors for 30-day mortality after TEVAR in TBAD patients.

Conclusion

Implanted stents ≥2

operation duration ≥2 h and implantation of PET-coverted stents are closely associated with the occurrence PIS in TBAD patients after TEVAR. Cystatin C level and PIS are primary risk factors for poor 30-day prognosis after TEVAR.

关键词

Keywords

references

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