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| 深低温停循环主动脉夹层手术后高胆红素血症的危险因素分析 |
| Risk factors for hyperbilirubinemia after aortic dissection surgery under deep hypothermic circulatory arrest |
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| DOI：10.12089/jca.2018.10.006 |
| 中文关键词: 深低温停循环 高胆红素血症 主动脉夹层 |
| 英文关键词: Deep hypothermic circulatory arrest Hyperbilirubinemia Aortic dissection |
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| 中文摘要: |
目的 研究深低温停循环(deep hypothermic circulatory arrest,DHCA)主动脉夹层手术后高胆红素血症的危险因素。
方法 回顾性分析青岛大学附属医院177例DHCA下Stanford A型夹层手术患者资料,男126例,女51例,年龄≥18岁,ASA均为Ⅳ级。将患者分为两组: 高胆红素血症组(HB组，n=96),血浆总胆红素(total bilirubin,TBIL)>51.3 μmol/L;正常组(N组，n=81),TBIL≤51.3 μmol/L。采用Logistic回归分析高胆红素血症的危险因素。
结果 术后高胆红素血症发生率为54.2％。阻断时间(OR=1.026,95％CI 1.005～1.048,P=0.017),术中输红细胞(OR=1.192,95％CI 1.032～1.378,P=0.017),术前TBIL(OR=1.098,95％CI 1.038～1.161,P=0.001)是DHCA主动脉夹层手术后高胆红素血症的独立危险因素。采用ROC曲线分析显示,阻断时间、术中输红细胞、术前TBIL的临界值分别为93.5 min、3.0 U、21.3 μmol/L。HB组术后输注血浆量明显多于N组(P<0.05)。HB组存活率明显低于N组(81.3％ vs 92.6％, P=0.03)。
结论 DHCA主动脉夹层手术后高胆红素血症的发生率较高,预后较差。阻断时间>93.5 min、术中输注红细胞>3.0 U、术前TBIL>21.3 μmol/L是高胆红素血症发生的危险因素。 |
| 英文摘要: |
Objective To evaluate the risk factors of hyperbilirubinemia after aortic dissection surgery under deep hypothermic circulatory arrest (DHCA).
Methods Data of consecutive 177 adult patients, 126 males and 51 females, aged ≥ 18 years, with Stanford A aortic dissection surgery under DHCA in Affiliated Hospital of Qingdao University were retrospectively reviewed. All patients were divided into two groups: hyperbilirubinemia group (group HB, n = 96, TBIL ＞ 51.3 μmol/L) and normal group (group N, n = 81, TBIL ≤ 51.3 μmol/L). Logistic regression was performed for risk factors of hyperbilirubinemia.
Results The incidence of hyperbilirubinemia after aortic dissection surgery under DHCA was 54.2％. The clamping time (OR = 1.026, 95％ CI 1.005 - 1.048, P = 0.017), red cells transfusion during surgery (OR = 1.192, 95％ CI 1.032 - 1.378, P = 0.017) and pre-surgery TBIL (OR = 1.098, 95％ CI 1.038 - 1.161, P = 0.001) were risk factors of hyperbilirubinemia after aortic dissection surgery under DHCA. ROC curve analysis showed that the cut-off values of clamping time, red cells transfusion during surgery and pre-surgery TBIL were 93.5 min, 3.0 U and 21.3 μmol/L respectively. The patients in HB needed more fresh frozen plasma. The survival rate of HB was lower than that in N (81.3％ vs 92.6％, P = 0.030).
Conclusion Hyperbilirubinemia remains common in patients after aortic dissection surgery under DHCA, and the prognosis was poor. Long clamping time (> 93.5 min) and red cells transfusion (> 3.0 U) during surgery, high pre-surgery TBIL (21.3 μmol/L) are risk factors of hyperbilirubinemia. |
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