累及主动脉弓的急性Stanford A型主动脉夹层孙氏手术后院内死亡的危险因素分析

摘要

Objective To evaluate the risk factors of Sun' s procedure for acute Stanford A type aortic dissection involving aortic arch.Methods Between February 2009 to February 2012,data from 233 patients who underwent Sun' s procedure for acute Stanford type A aortic dissection involving aortic arch were collected retrospectively.All the risk factors related to mortality were analyzed by univariate statistical analysis.Significant univariate variables were entered into multiple logistic analysis.Results Total 23 patients died in the hospital and the mortality was 9.87 ％.Univariate analysis showed that age,limb ischemia,and cardiopulmonary bypass longer than 268 minutes were risk factors for mortality.After these factors were entered into multiple logistic regression analysis,multiple logistic regression showed that age(P =0.017,OR =1.062),cardiopulmonary by pass time longer than 268 minutes(P =0.001,OR =6.150) were final independent risk factors for mortality.ConclusionAge and cardiopulmonary bypass time longer than 268 minutes were final independent risk factors for mortality.Longer cardiopulmonary bypass time should be avoided.%目的 探讨急性累及主动脉弓的Stanford A型主动脉夹层患者孙氏术后院内死亡的危险因素.方法 2009年2月至2012年2月,233例累及主动脉弓的急性Stanford A型主动脉夹层患者纳入研究.将可能与术后死亡相关的因素先行单因素分析,单因素分析有意义的变量纳入多因素logistic回归分析.结果 孙氏术后院内死亡23人,占9.87％.单因素分析结果显示,年龄、术前肢体缺血、体外循环超过268 min为术后院内死亡的危险因素.将此3种危险因素纳入多因素logistic回归,结果显示,年龄(P=0.017,OR=1.062)、体外循环超过268 min(P =0.001,OR =6.150)为孙氏术后患者死亡的独立危险因素.结论 年龄和长时间体外循环(超过268 min)为孙氏术后患者死亡的独立危险因素,术中尽可能缩短体外循环时间能减少术后死亡.