Duan Xu-Zhou, Xu Zhi-Yun, Lu Fang-Lin, Han Lin, Tang Yang-Feng, Tang Hao, Liu Yang
Department of Cardiothoracic Surgery, Changhai Hospital, Second Military Medical University, Shanghai 200433, China.
J Thorac Dis. 2018 Mar;10(3):1628-1634. doi: 10.21037/jtd.2018.03.48.
Preoperative hypoxemia is a frequent complication of acute Stanford type A aortic dissection (ATAAD). The aim of the present study was to determine which factors were associated with hypoxemia.
A series of data were collected in a statistical analysis to evaluate preoperative hypoxemia in patients with ATAAD. After retrospectively analyzing data for 172 patients, we identified the risk factors for preoperative hypoxemia. Hypoxemia was defined by an arterial partial pressure of oxygen to fraction of inspired oxygen (PaO/FiO) ratio of 200 or lower. Subsequent to identifying the patient population, a prospective study was conducted using ulinastatin as a preoperative intervention. The ulinastatin group received ulinastatin at a total dose of 300,000 units prior to surgery. All the pertinent factors were investigated through univariate and multiple logistic regression analysis.
The factors associated with preoperative hypoxemia in ATAAD comprised the following: body mass index (BMI) ≥25; white blood cell count (WBC) and neutrophil counts; levels of C-reactive protein (CRP), D-dimer, and interleukin-6 (IL-6); ATAAD involving the celiac trunk, renal artery, or mesenteric artery. Logistic regression analysis showed that CRP and IL-6 levels were independent predictive factors. We found that ulinastatin effectively could improve oxygenation, since compared to the control group the oxygenation in the ulinastatin group was significantly improved.
Systemic inflammatory reactions played a vital role in preoperative hypoxemia after the onset of ATAAD. The oxygenation of the patient could be improved significantly by inhibiting the inflammatory response prior to surgery.
术前低氧血症是急性 Stanford A 型主动脉夹层（ATAAD）常见的并发症。本研究旨在确定哪些因素与低氧血症相关。
收集一系列数据进行统计分析，以评估 ATAAD 患者的术前低氧血症情况。在对 172 例患者的数据进行回顾性分析后，我们确定了术前低氧血症的危险因素。低氧血症定义为动脉血氧分压与吸入氧分数（PaO₂/FiO₂）比值≤200。确定患者群体后，进行了一项前瞻性研究，使用乌司他丁作为术前干预措施。乌司他丁组在手术前接受总剂量为 30 万单位的乌司他丁。通过单因素和多因素逻辑回归分析研究所有相关因素。
ATAAD 患者术前低氧血症相关因素包括：体重指数（BMI）≥25；白细胞计数（WBC）和中性粒细胞计数；C 反应蛋白（CRP）、D - 二聚体和白细胞介素 - 6（IL - 6）水平；ATAAD 累及腹腔干、肾动脉或肠系膜动脉。逻辑回归分析表明，CRP 和 IL - 6 水平是独立预测因素。我们发现乌司他丁可有效改善氧合，因为与对照组相比，乌司他丁组的氧合情况显著改善。
全身炎症反应在 ATAAD 发病后的术前低氧血症中起重要作用。术前抑制炎症反应可显著改善患者的氧合情况。
