Risk Factors for Prolonged Mechanical Ventilation Following Surgery for Acute Type A Aortic Dissection
Risk Factors for Prolonged Mechanical Ventilation Following Surgery for Acute Type A Aortic Dissection
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DOI：
10.1253/circj.cj-08-0306
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发表时间：
2008-11-01
影响因子：
3.3
通讯作者：
Adachi, Hideo
中科院分区：
文献类型：
--
作者：
Kimura, Naoyuki;Tanaka, Masashi;Adachi, Hideo
背景：本研究的目的是确定急性A型主动脉夹层(AAAD)手术后机械通气时间延长的预测因素，并评估这一并发症对临床结果的影响。方法与结果1997-2006年间，243例AAAD患者接受了急诊手术。术后48h内死亡10例。其余233例患者按机械通气时间分为两组：48h以下(A组：149例)和48h以上(13例，n=84)。多变量分析用于确定PMV的预测因素。比较两组间的近期和远期疗效。多因素分析显示休克(收缩压90毫米汞柱；p=0.007)、术后肾功能不全(肌酐2.0 mg/dl；p=0.016)、冠状动脉旁路移植术(p=0.017)和肢体缺血(p=0.044)是PMV的独立预测因素。住院病死率(A组2.7%比B组3.6%)和5年生存率(A组85.9%比13组76.8%)差异无统计学意义。结论休克、肢体缺血、冠状动脉旁路移植术和术后肾功能不全是PMV的危险因素。了解PMV的预测因素有助于优化这些患者的术后处理。(中国保监会J 2008；72：1751-1757)
Background The aim of this study was to identify predictors of prolonged mechanical ventilation (PMV) following surgery for acute type A aortic dissection (AAAD) and to assess the influence of this complication on clinical outcomes.Methods and Results A total of 243 patients underwent emergency surgery for AAAD in the period of 1997-2006. Ten patients died within 48 h after surgery. The remaining 233 patients were divided into 2 groups according to the duration of mechanical ventilation; less than 48 h (group A: n=149) or 48 h or longer (group 13; n=84). Multivariate analysis was used to identify predictors of PMV. Short and late outcomes were compared between groups. Multivariate analysis showed that shock (systolic BP < 90 mmHg; p=0.007), postoperative renal dysfunction (creatinine > 2.0 mg/dl; p=0.016), coronary artery bypass grafting (CABG) (p=0.017), and limb ischemia (p=0.044) were independent predictors of PMV. There was no significant difference in in-hospital mortality (group A, 2.7% vs group B, 3.6%) or 5-year survival (group A, 85.9% vs group 13, 76.8%).Conclusions Shock, limb ischemia, CABG, and postoperative renal dysfunction increase the risk for PMV. Knowing the predictors of PMV should help optimize postoperative management of these patients. (Circ J 2008; 72: 1751-1757)