急性Stanford A型主动脉夹层患者术后肝功能不全的危险因素及预后分析

目的 探讨急性Stanford A型主动脉夹层患者术后发生肝功能不全(HD)的危险因素和预后.方法 回顾性分析青岛市市立医院2014年5月至2018年5月156例接受外科手术的急性Stanford A型主动脉夹层患者围术期资料.采用终末期肝病模型(MELD)评分评估患者术后肝功能,并分为HD组35例(MELD评分≥15...

Risk factors and prognostic analysis for postoperative hepatic dysfunction in patients with Stanford type A acute aortic dissection

Objective To explore the prognosis and risk factors of postoperative hepatic dysfunction(HD)in patients with Stanford type A acute aortic dissection.Methods Patients with Stanford type A acute aortic dissection who underwent surgery in Qingdao Municipal Hospital from May 2014 to May 2018 were retrospectively analyzed.Postoperative model for end-stage liver disease(MELD)score was used to define HD.Patients were divided into two groups based on their hepatic function.There were 35 patients in HD group(MELD≥15)and 121 patients in non-HD group(MELD<15).Univariable and multivariable logistic regression analysis were used to identify the predictive risk factors.The prognosis of the two groups was compared.Results A total of 156 patients were enrolled.Overall in-hospital mortality was 8.3%(13 cases).Mortality in HD group was 20.0%(7 cases),while that in non-HD group was 5.0%(6 cases).Univariate analysis showed that there were significant differences in preoperative alanine aminotransferase(ALT),preoperative creatinine,cardiopulmonary bypass(CPB)time,preoperative leucocyte,preoperative D-dimer,European system for cardiac operative risk evaluation(EuroSCORE),intraoperative and 24 h postoperative red blood cell transfusion volume and number of aortic arch surgery between the two groups.Multivariate logistic analysis showed that preoperative ALT(OR=1.244,95%CI:1.100-1.406,P=0.001),CPB time(OR=1.104,95%CI:1.041-1.170,P=0.001),and red blood cell transfusion(OR=4.717,95%CI:2.278-9.767,P=0.000)were the independent risk factors for postoperative HD.The average time of follow-up was(22.9±3.2)months,and the lost follow-up rate was 9.1%.The short-and middle-term mortality was higher in HD group than that in non-HD group(14.3%vs.2.6%,Log-rank P=0.009).Conclusions The incidence of postoperative HD is high in patients with Stanford type A acute aortic dissection.Elevated preoperative ALT,prolonged CPB time,and red blood cell transfusion volume during and 24 h after surgery are the independent risk factors for postoperative HD.The short-and middle-term mortality of these patients are significantly increased.