DebakeyⅠ型主动脉夹层术后急性呼吸功能不全的危险因素

目的 分析DebakeyⅠ型主动脉夹层术后急性呼吸功能不全（acute respiratory insufficiency，ARI)的相关因素。方法39例DebakeyⅠ主动脉夹层患者在深低温停循环下行手术治疗。收集患者术前、术中可疑变量进行统计分析〔(年龄、性别、高血压病、吸烟史、体质量指数(BMI)、术前氧合指数、灌注不良综合征、发病至手术时间、术后24 h内输注红细胞及血浆量、胸膜破裂、术后24 h胸管引流量、体外循环(cardiopulmonary bypass，CPB)时间、深低温停循环(deep hypothermic circulatory arrest，DHCA)时间、主动脉阻断时间〕。先对上述变量进行单因素分析，再将单因素分析中有统计学意义的变量，代入Logistic回归模型中进行多因素分析。结果 入选呼吸功能不全患者30例，无呼吸功能不全患者9例。单因素分析结果显示吸烟史、BMI>25 kg/m2、术前氧合指数<300、手术距发病时间<2周、灌注不良综合征、CPB时间>160 min、术后24 h红细胞输入量>10 U、术后24 h血浆输入量>1 000 ml有统计学意义（P<0.05）。多因素Logistic 回归分析的结果显示，以下因素为术后发生ARI的独立危险因素:BMI>25 kg/m2（P<0.01）；术前氧合指数<300（P<0.05）；术前灌注不良综合征（P<0.01）；术后24 h血浆输入量>1 000 ml（P<0.05）；CPB时间>160 min（P<0.01）。结论 DebakeyⅠ主动脉夹层患者深低温停循环术后发生ARI的危险因素包括:BMI>25 kg/m2；术前氧合指数<300；术前灌注不良综合征；术后24 h血浆输入量>1 000 ml；CPB时间>160 min。

Risk factors for acute respiratory insufficiency after Debakey type I aortic dissection

AIM To analyze related factors of postoperative acute respiratory insufficiency (ARI) following Debakey type I aortic dissection. METHODS Thirty-nine Debakey type I aortic dissection patients who underwent surgery under deep hypothermic circulatory arrest (DHCA) were enrolled in the study. Pre- and postoperative suspected risk factors were analyzed including age, gender, history of hypertension, smoking, body mass index (BMI), preoperative ratio of fraction of inspired oxygen to oxygen pressure (PaO2/FiO2), preoperative malperfusion, duration of onset to operation, amount of transfused red blood cells and plasma within 24 h after surgery, rupture of pleura, postoperative drainage of chest tube within 24 h, cardiopulmonary bypass (CPB) time, deep hypothermic circulatory arrest (DHCA) time and cross-clamping time. Univariate analysis was performed to assess these factors and screen the statistically significant factors for multivariate regression analysis with logistic regression model. RESULTS Thirty ARI patients and nine non-ARI patients were classified. Univariate analysis showed that the factors that reached statistical significance were smoking, BMI>25 kg/m2, preoperative PaO2/FiO2<300, duration of onset to operation<2 weeks, preoperative malperfusion, CPB time>180 min, amount of transfused red blood cells within 24 h>10 U, amount of transfused plasma within 24 h>1 000 ml. Multivariate analysis indicated that BMI >25 kg/m2 (P<0.01), preoperative PaO2/FiO2<300 (P<0.05), preoperative malperfusion (P<0.01), amount of transfused plasma within 24 h>1 000 ml (P<0.05) and CPB time>180 min (P<0.01) were statistically significant risk factors for ARI after surgery. CONCLUSION The risk factors of postoperative ARI following Debakey type I aortic dissection under DHCA include BMI>25 kg/m2, preoperative PaO2/FiO2<300, preoperative malperfusion, amount of transfused plasma within 24 h>1 000 ml and CPB time >180 min.