急性Stanford A型主动脉夹层术后死亡因素分析

目的 分析探讨急性Stanford A型主动脉夹层患者手术后死亡相关危险因素.方法 回顾性分析2003年1月至2008年6月复旦大学附属中山医院心外科接受手术治疗的急性Stanford A型主动脉夹层患者共185例,其中男性144例(77.8%),女性41例(22.2%);年龄(49.46±11.04)岁.对该组患者术后转归进行单因素和多因素Logistic回归分析.结果 术后30 d内总死亡率9.1%,单因素分析或多因素Logistic回归分析结果:术前神经系统表现阳性(单因素OR=5.084,CI=1.792～14.426,P=0.002;多因素OR=5.538,CI=1.834～16.721,P=0.002),低血压(单因素OR=6.986,CI=1.510～32.323,P=0.013;多因素OR=1.998,CI=0.315～12.679,P=0.463),肾功能不全(单因素OR=3.594,CI=1.237～10.438,P=0.019;多因素OR=3.254,CI=1.034～10.242,P=0.044).结论 术前神经系统表现阳性、肾功能不全是急性Stanford A型主动脉夹层患者手术后死亡的独立危险因素.

Analysis of risk factors of operation on 185 patients with acute type A aortic dissection

Objective To assess the risk factors of the in-hospital mortality of acute type A aortic dissection after operation. Method From January 2003 to June 2008,185 patients, 144 males and 41 females, with acute type A aortic dissection operated on were enrolled. The average age of patients was (49.46 ± 11.04 ) years old.The patients' demographics, history, clinical features, and some laboratory examinations were reviewed. Univariate and multivariate analysis followed by logistic regression analysis were carried out to identify the predictors of inhospital mortality. Results The in-hospital mortality rate was 9.1%. The results of univariate and multivariate analyses as follows: pre-operation positive neurological symptom (Univariate OR = 5.084,95%CI:1.792 -14.426, P = 0.002; Multivariate OR = 5.538,95%CI: 1.834 - 16.721, P = 0.002, respectively), hypotension (Univariate OR = 6.986,95%CI:1.510- 32.323,P =0.013; multivariate OR = 1.998,95%CI:0.315-12.679,P = 0.463, respectively) and renal failure (Univariate OR = 3.594,95%CI:1.237 - 10.438,P =0.019; Multivariate OR = 3.254,95%CI:1.034- 10.242, P= 0.044, respectively). Conclusions There are two predictors, pre-operation positive neurological symptom and renal failure, of pre-hospital mortality found in current analyses. Our results may improve the regimen made by cardiac surgeons and emergency doctors so as to help patients and their relatives to make correct decision.