急性Stanford A型主动脉夹层围术期急性肺损伤与D-二聚体相关性的探讨

目的:探讨急性Stanford A型主动脉夹层围术期急性肺损伤(ALI)的发生与D-二聚体(DD)的相关性。方法:2011年6月至2012年5月,连续收治59例急性主动脉夹层患者,均行全弓置换+支架象鼻手术。根据围术期发生ALI的情况分组:a组(10例):术前、术后均发生ALI;b组(17例):术前未发生ALI,但术后发生ALI;c组(32例):术前术后均未发生ALI。各组间结果比较采用方差分析,各因素与氧合指数的相关性采用多元线性回归分析。结果:三组术前DD比较:a组与b组、a组与c组P<0.05;b组与c组均P>0.05。术后24 h、48 h DD比较:a组与c组、b组与c组均P<0.05,a组与b组P>0.05。多元线性回归分析DD升高水平与PaO2/FiO2呈负相关性(γ=-0.032,P<0.001)。三组术后呼吸机使用时间和ICU停留时间比较:a组与c组、b组与c组均P<0.05;a组与b组P>0.05。术后有3例患者死亡,2例术后二次开胸探查,6例术后存在并发症,此11例术后均为ALI患者。结论:急性夹层围术期发生ALI的患者,有一个高的DD水平,且DD与PaO2/FiO2呈负相关性;术后发生ALI的患者,呼吸机使用时间与ICU停留时间显著延长。

The correlation of the acute lung injury and D-dimer of acute Stanford type A aortic dissection in perioperative period

Objective:To analyze the correlation of the acute lung injury(ALI)and D-dimer(DD)of acute Stanford type A aortic dissection in perioperative period.Methods:59 cases of acute aortic dissection patients were treated continuously from June 2011 to May 2012.All of the cases underwent total arch replacement and stented elephant trunk.Grouped the cases according to the situation of perioperative ALI:group a(10 cases):ALI occurred in perioperative period;group b(17 cases):ALI did not occur preoperative but postoperative;group c(32 cases):ALI did not occurr in perioperative period.Groups were compared with the analysis of variance,correlation analysis with multiple linear regression.Results: Compare preoperative DD of the three groups:group a and b、group a and c(P<0.05);group b and c(P>0.05).The results of 24 h、48 h after surgery:group a and c、group b and c(P<0.05);group a and b(P>0.05).DD and PaO2/FiO2 present a negative correlation(b=-0.032,P<0.001).Campared ventilation time and ICU residence time of the three groups after surgery:group a and c、group b and c(P<0.05);group a and b(P>0.05).There were 3 patients died,2 cases had postoperative secondary exploratory thoracotomy and 6 cases had postoperative complications.All of the 11 patients were ALI postoperative.Conclusion:The acute dissection perioperative patients with ALI had a high DD level.DD and PaO2/FiO2 present a negative correlation.Ventilation time and ICU residence time of the patient with ALI postoperative significantly prolonged.