| 17 | 0 | 11 |
| 下载次数 | 被引频次 | 阅读次数 |
目的 探讨老年A型主动脉夹层患者术后出现急性呼吸功能不全(ARI)的影响因素。方法 选取老年A型主动脉夹层患者100例，通过电子病历系统采集患者临床资料，按患者住院期间是否发生ARI分为ARI组(n=77)和非ARI组(n=23),多因素Logistic回归分析老年主动脉夹层患者术后发生ARI的影响因素，受试者工作特征(ROC)曲线分析Logistic回归模型对老年主动脉夹层患者术后发生ARI的预测价值。结果 ARI组与非ARI组术后血氧分压/吸入氧浓度(PaO2/FiO2)、术前灌注不良综合征、术后24 h血浆输入量、体外循环(CPB)时间、体质量指数(BMI)差异显著(P<0.05);多因素Logistic回归分析显示，BMI、术前灌注不良综合征、术后24 h血浆输入量、CPB时间均为老年主动脉夹层患者术后发生ARI的独立危险因素，术后PaO2/FiO2是其保护因素(P<0.05)。依据Logistic回归分析结果，通过Predict Prel程序将回归方程拟合一个新变量P,P=0.750+0.287×BMI-术后PaO2/FiO2×0.079+术前灌注不良综合征×1.172+术后24 h血浆输入量×0.036+CPB时间×0.136,ROC曲线显示，P预测老年主动脉夹层患者术后发生ARI的曲线下面积(AUC)为0.915(95%CI 0.845～0.985),灵敏度为0.961,特异度为0.870,约登指数为0.831。结论 BMI、术前PaO2/FiO2、术前存在灌注不良、术后血浆输入量与CPB时间等因素显著影响老年主动脉夹层患者术后急性呼吸功能不全的概率，基于这些因素，构建的预测模型准确定位高风险个体，AUC值达0.915,为临床预防该并发症提供了有力工具。
Abstract：1 Melvinsdottir IH,Lund SH,Agnarsson BA,et al.The incidence and mortality of acute thoracic aortic dissection:results from a whole nation study[J].Eur J Cardiothorac Surg,2016;50(6):1111-7.
2 杜美兰.应用三分支覆膜支架治疗14例主动脉夹层患者的术中护理[J].中华护理杂志，2014;49(3):382-4.
3 Peterson MD,Mazine A,El-Hamamsy I,et al.Knowledge,attitudes,and practice preferences of Canadian candiac surgeons toward the management of acute type a aortic dissection[J].J Thorac Cardiovasc Surg,2015;150(4):824-31.
4 Lee C,Colletti PM,Chung JH,et al.ACR appropriateness criteria? acute respiratory illness in immunocompromised patients[J].J Am Coll Radiol,2019;16(11S):S331-9.
5 徐向朋，高玉芳，张彬彬，等.Stanford A型主动脉夹层患者术后拔除气管插管预防性给予高流量氧疗的效果评价[J].中华护理杂志，2018;53(5):568-72.
6 中国医师协会心血管外科分会大血管外科专业委员会.主动脉夹层诊断与治疗规范中国专家共识[J].中华胸心血管外科杂志，2017;33(11):641-54.
7 M?ller CM,Ellmauer PP,Zeman F,et al.Postoperative acute respiratory dysfunction and the influence of antibiotics after acute type A aortic dissection surgery:a retrospective analysis[J].PLoS One,2021;16(2):e0246724.
8 Miyagawa M,Yagi T,Sugai S,et al.Venovenous extracorporeal membrane oxygenation for acute respiratory distress syndrome due to an acute type B aortic dissection:a case report[J].Perfusion,2022;37(4):426-8.
9 Ozawa K,Shimura S,Odagiri S,et al.Nitric oxide inhalation and V-V ECMO for severe respiratory failure after acute type a aortic dissection surgery[J].Tokai J Exp Clin Med,2022;47(1):13-7.
10 Chen CW,Tseng YH,Lin CC,et al.Aortic dissection assessment by 4D phase-contrast MRI with hemodynamic parameters:the impact of stent type[J].Quant Imag Med Surg,2021;11(2):490-501.
11 Magrone T,Simone M,Altamura M,et al.Characterization of the immune inflammatory profile in obese asthmatic children[J].Endocr Metab Immune Disord Drug Targets,2014;14(3):187-95.
12 Fuentes YV,Ibáňez-Prada ED,Serrano-Mayorga CC,et al.Prevalence,incidence,and severity associated with viral respiratory tract infections in Colombian adults before the COVID-19 pandemic[J].J Infect Public Health,2022;15(12):1381-7.
13 Ram H,Weaver AR,Dorfling J.Iatrogenic aortic intramural hematoma:guidance to intraoperative decision making:a case report[J].A A Pract,2020;14(6):e01191.
14 Baguet JP,Chavanon O,Sessa C,et al.European society of hypertension scientific newsletter:hypertension and aortic diseases[J].J Hypertens,2012;30(2):440-3.
15 Kanbay M,Ertuglu LA,Afsar B,et al.An update review of intradialytic hypotension:concept,risk factors,clinical implications and management[J].Clin Kidn J,2020;13(6):981-93.
16 Correia CJ,Ricardo da Silva FY,Armstrong RJ,et al.Sex differences in the coagulation process and microvascular perfusion induced by brain death in rats[J].Transpl Int,2020;33(11):1541-50.
17 Smith JR,Olson TP.Ventilatory constraints influence physiological dead space in heart failure[J].Exp Physiol,2019;104(1):70-80.
18 Marchi NA,Ramponi C,Hirotsu C,et al.Mean oxygen saturation during sleep is related to specific brain atrophy pattern[J].Ann Neurol,2020;87(6):921-30.
基本信息:
DOI：
中图分类号:R654.3
引用信息:
[1]刘英培,王晓洁,马国锋等.老年A型主动脉夹层患者术后急性呼吸功能不全的影响因素[J].中国老年学杂志,2025,45(11):2569-2572.
基金信息:
河南省医学科技攻关联合共建项目(LHGJ20210600)