主动脉夹层围手术期死亡危险因素的预测分析

目的 探讨预测主动脉夹层围手术期死亡危险因素.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主动脉夹层361例患者的病历资料,对患者转归进行单因素以及多因素回归分析.结果 单因素分析提示高血压病史(OR 0.465,95%CI 0.229-0.947,P=0.035),急性病程(OR 7.897,95% CI 1.874～33.275,P=0.005),Stanford A型(OR 2.758,95%CI1.054～7.213,P=0.039),神经系统症状阳性(OR 0.275,95% CI 0.140～0.541,P<0.001),手术与否(OR 8.206,95%CI 4.205～16.012,P<0.001)与转归相关,多因素回归分析提示急性病程(OR8.178,95% CI 1.796～37.242,P=0.007)、Stanford A型(OR 3.236,95% CI 1.104～9.487,P=0.032)、神经系统症状阳性(OR 0.350,95% CI 0.159～0.770,P=0.009)以及手术与否(OR 9.429,95% CI 4.456～19.952,P<0.001)对预后有重要影响.结论 高血压病史、急性病程、Stanford A分型、神经系统症状阳性是主动脉夹层围手术期死亡预测因素,手术与否是患者转归的决定性因素.

Predictors of peri-operative mortality in patients with aortic dissection

Objective To analyze the peri-operative risk factors of mortality in patients with aortic dissection (AD). Methods Between January 2003 and June 2008, 361 AD patients at our hospital were enrolled. Their demographics, history, clinical characteristics and laboratory examinations were retrospectively analyzed. Twenty pre-operative variables were analyzed to identify the predictors of perioperative mortality of AD patients by the analyses of univariate and multivariate logistic regression.Results The analysis of univariate logistic regression showed that history of hypertension [odds ratio (OR)0.465, 95% confidence interval (CI) 0.229 -0.947, P = 0.035], Stanford type A (OR 2. 758,95% CI 1.054- 7.213 P = 0.039), acute course (OR 7. 897,95 % CI 1. 874-33. 275 P = 0.005), neurological symptoms (OR 0.275 ,95% CI 0.140 -0.541 ,P <0.001) and operation or not (OR 8. 206 ,95% CI 4.205 -16.012,P <0.001) had a higher mortality in AD patients. The multivariate analysis revealed that acute course (OR 8. 178 ,95% CI 1. 796-37. 242, P = 0.007), Stanford type A (OR 3. 236 ,95% CI 1.104-9.487 P = 0.032), neurological symptoms (OR 0.350 , 95% CI 0.159-0.770, P = 0.009) and operation or not (OR 9.429 ,95% CI 4. 456-19. 952 ,P <0.001) were significant independent predictors of perioperative mortality in AD patients. Conclusion History of hypertension, acute course, Stanford A and positive neurological symptoms are the independent predictors of perioperative mortality in AD patients.Operation or not is a determinant of patient outcome.