Guan Xinliang, Gong Ming, Wang Xiaolong, Zhu Junming, Liu Yongmin, Sun Lizhong, Zhang Hongjia
Department of Cardiac Surgery, Beijing Aortic Disease Center, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing Lab for Cardiovascular Precision Medicine, and Beijing Engineering Research Center of Vascular Prostheses, Beijing, China.
Medicine (Baltimore). 2018 May;97(21):e10830. doi: 10.1097/MD.0000000000010830.
Aortic arch surgery in patients with acute aortic dissection is frequently complicated by neurological complications and coagulopathy. However, the relationship between the coagulation system and neurological complications in patients with acute aortic dissection has not been clarified. Thus, the aim of this study was to investigate the relationship between the coagulation system and neurological complications in patients with acute aortic dissection.From September 2014 to January 2016, a total of 126 patients with acute type A aortic dissection were enrolled. Perioperative characteristics and standard laboratory tests upon admission were analyzed using univariate and multivariate logistic regression analysis in this study. The primary outcome was the correlation between the coagulation system and neurological complications.Univariate logistic regression analysis showed that the neurological complications (+) group underwent more serious and complicated postoperative outcomes. Multivariable logistic regression analysis revealed serum creatinine level (OR, 1.049; 95% CI, 1.011-1.089; P = .01), white blood cell counts (OR, 1.581; 95% CI, 1.216-2.057; P = .001) and fibrinogen concentration upon admission (OR, 0.189; 95% CI, 0.060-0.596; P = .004) as predictors of neurological complications. However, we found that there was no association between the coagulation system and in-hospital mortality.Low preoperative fibrinogen level is the preferred marker for predicting clinical neurological complications in patients with acute type A aortic dissection treated with surgical repair.
急性主动脉夹层患者的主动脉弓手术常并发神经并发症和凝血病。然而，急性主动脉夹层患者凝血系统与神经并发症之间的关系尚未阐明。因此，本研究的目的是探讨急性主动脉夹层患者凝血系统与神经并发症之间的关系。
2014年9月至2016年1月，共纳入126例急性A型主动脉夹层患者。本研究采用单因素和多因素logistic回归分析对入院时的围手术期特征和标准实验室检查进行分析。主要结局是凝血系统与神经并发症之间的相关性。
单因素logistic回归分析显示，神经并发症（+）组术后结局更严重、更复杂。多因素logistic回归分析显示，血清肌酐水平（OR，1.049；95%CI，1.011 - 1.089；P = 0.01）、白细胞计数（OR，1.581；95%CI，1.216 - 2.057；P = 0.001）和入院时纤维蛋白原浓度（OR，0.189；95%CI，0.060 - 0.596；P = 0.004）是神经并发症的预测因素。然而，我们发现凝血系统与院内死亡率之间没有关联。
术前纤维蛋白原水平低是预测接受手术修复的急性A型主动脉夹层患者临床神经并发症的首选标志物。
