急性主动脉夹层动脉瘤开胸术后并发低氧血症危险因素分析

摘要

目的 分析急性主动脉夹层动脉瘤患者开胸术后并发低氧血症的危险因素.方法 回顾性分析2009年2月至2014年12月于本院住院并行开胸术的89例急性主动脉夹层动脉瘤患者的临床资料,根据患者术后是否发生低氧血症将其分为低氧血症组与非低氧血症组.对比分析两组患者的临床资料,采用多因素Logistic回归分析探讨患者并发低氧血症的危险因素.结果 89例患者中发生低氧血症42例(47.2%),死亡7例(7.9%),其中低氧血症组患者死亡率(11.9%)高于非低氧血症组(4.3%),但差异无显著性(P>0.05).多因素Logistic回归分析显示,急性主动脉夹层动脉瘤患者开胸术后并发低氧血症的独立危险因素为:体质指数>25 kg/m2(OR=2.643)、术中及术后输血量≥8 U(OR=3.083)、术后血糖水平>11.1 mmol/L(OR=2.973)、术前氧合指数≤300 mmHg(OR=3.193)、深低温停循环(OR=2.863),差异均具有显著性(P<0.05).结论 对于超重、肥胖及术前氧合指数较低的急性主动脉夹层动脉瘤患者,术前应给予早期干预,术中及术后应避免输注过多的血液制品,积极控制术后应激性高血糖,以减少术后低氧血症的发生.%Objective To analyze the risk factors of hypoxemia after thoracotomy in patients with acute dissecting aneurysm of aorta. Method The clinical datas of 89 patients with acute dissecting aneurysm of aorta who underwent thoracotomy in our hospital from February 2009 to December 2014 were retrospectively analyzed, they were divided into hypoxemia group and non-hypoxemia group according to whether they had postoperative hypoxemia. The clinical datas of the two groups were analyzed and compared, and multivariate Logistic regression was used to analyze the risk factors of hypoxemia. Result 42 cases of hypoxemia occurred in 89 patients, the incidence was 47.2%. There were 7 cases of death, the mortality rate was 7.9%, hypoxemia group had a higher mortality rate than non-hypoxemia group (11.9%︰4.3%), but there was no significant difference (P>0.05). Multivariate Logistic regression analysis showed that independent risk factors of hypoxemia in patients with acute dissecting aneurysm of aorta after thoracotomy were body mass index > 25 kg/m2(OR = 2.643),intraoperative and postoperative blood transfusion volume ≥ 8 U (OR=3.083),postoperative blood glucose levels>11.1 mmol/L(OR=2.973),preoperative PaO2/FiO2≤300 mmHg(OR=3.193), deep hypothermic circulatory arrest(OR = 2.863),the differences were significant(P < 0.05).Conclusion For acute dissecting aneurysm of aorta patients with overweight, and obesity, low PaO2/FiO2before operation, early intervention should be given before operation, and to avoided during and after surgery, and should actively control the postoperative stress hyperglycemia, to reduce the occurrence of hypoxemia.