Vocal cord paralysis after aortic arch surgery: Predictors and clinical outcome
Vocal cord paralysis after aortic arch surgery: Predictors and clinical outcome
复制标题
DOI：
10.1016/j.jvs.2005.11.054
复制
发表时间：
2006-04-01
影响因子：
4.3
通讯作者：
Mori, T
中科院分区：
文献类型：
--
作者：
Ohta, N;Kuratani, T;Mori, T
目的：对某综合医院14年主动脉弓手术后声带麻痹患者资料进行回顾性队列研究。探讨主动脉弓术后声带麻痹发生的因素，以及声带麻痹对临床病程和预后的影响。我们回顾了1989年至2003年间因主动脉弓动脉瘤和主动脉夹层而接受主动脉弓手术的182例患者的资料，其中58例进行了近端主动脉弓修复，62例进行了远端主动脉弓修复，62例进行了全弓修复。我们评估了与声带麻痹发展相关的因素，并详细检查了声带麻痹患者的临床结果。结果：40例患者术后出现声带麻痹。多元logistic回归分析显示，声带麻痹的危险因素有以下优势比（OR）：手术延伸至远弓（OR, 17.0）、左锁骨下动脉主动脉慢性扩张（OR, 9.14）和全弓修复（OR, 4.24）。采用开放式支架可降低声带麻痹的发生率（OR, 0.031）。术后发生声带麻痹本身是肺部并发症的独立预测因子（OR, 4.12），并导致住院时间延长。主动脉弓手术后声带麻痹的风险取决于手术因素，如动脉瘤累及远端弓，或采用较新的、侵入性较小的手术方法。主动脉弓手术后声带麻痹本身，在积极的术后呼吸管理下，不会增加吸入性肺炎，但与术后并发症相关，导致更高的住院死亡率和住院时间延长。
Objective: This study is retrospective cohort study of data on vocal cord paralysis after aortic arch surgery collected during 14 years at a general hospital. We investigated factors in the development of vocal cord paralysis after aortic arch surgery and the effect of vocal cord paralysis on clinical course and outcome.Methods. We reviewed data for 182 patients who underwent aortic arch surgery for aortic arch aneurysm and aortic dissection between 1989 and 2003, of whom 58 patients had proximal aortic repair, 62 had distal arch repair, and 62 had total arch repair. We assessed factors associated with the development of vocal cord paralysis and examined in detail the clinical outcome of patients with vocal cord paralysis.Results: Postoperative vocal cord paralysis occurred in 40 patients. Multiple logistic regression analysis revealed the following risk factors with odds ratios (OR) for vocal cord paralysis: extension of procedures into distal arch (OR, 17.0), chronic dilatation of the aorta at the left subclavian artery (OR, 9.14), and total arch repair (OR, 4.24). Adoption of open-style stent-grafts reduced the incidence of vocal cord paralysis (OR, 0.031). The postoperative occurrence of vocal cord paralysis itself emerges as an independent predictor of pulmonary complications (OR, 4.12) and leads to a longer duration of hospital stay.Conclusions. The risk of vocal cord paralysis after aortic arch surgery depends on surgical factors, such as aneurysmal involvement of the distal arch, or the application of newer, less invasive surgical procedures. Vocal cord paralysis after aortic arch surgery itself, under aggressive postoperative respiratory management, did not increase aspiration pneumonia but was associated with postoperative complications leading to higher hospital mortality and prolonged hospitalization.