Jiang Li, Chen Sai, Jian Zhao, Xiao Yingbin
Department of Cardiovascular Surgery, Chengdu Military General Hospital, Chengdu, China.
Department of Cardiovascular Surgery, Xinqiao Hospital, Third Military Medical University, Chongqing, 400037, China.
Heart Surg Forum. 2018 May 30;21(3):E221-E228. doi: 10.1532/hsf.1983.
Surgery is a definitive treatment for patients with type A aortic dissection. The aim of this study was to identify and analyze the risk factors for permanent neurological dysfunction (PND) and 30-day mortality in patients following total arch replacement and stented elephant trunk implantation in the descending aorta. Methods: The clinical data of 85 consecutive patients who underwent this surgical procedure between December 2013 and May 2017 were reviewed. Multivariate logistic regression analysis was performed to determine the independent predictors of postoperative PND and 30-day mortality. Results: There were 62 males and 23 females, with a mean age of 47.6 ± 11.7 years (range, 26-73 years). Ten patients (11.76%) developed PND after surgery. Postoperative 30-day mortality was 11.76% (10/85), including one death during hospitalization and nine deaths after discharge. Multivariate analysis showed that hypertension was independently associated with postoperative PND (OR = 4.407, 95% CI: 1.021-19.023, P = .047), and age and postoperative PND were independent predictors for 30-day mortality (OR, 1.120; 95% CI, 1.026-1.221; P = .011 and OR, 7.503; CI, 1.290-43.634; P = .025, respectively). Conclusion: Hypertension was independently associated with postoperative PND, and age and postoperative PND were predictors for early mortality in patients who underwent total arch replacement and stented elephant trunk implantation.
手术是A型主动脉夹层患者的确定性治疗方法。本研究的目的是识别和分析在全主动脉弓置换并在降主动脉植入带支架象鼻术后患者发生永久性神经功能障碍（PND）和30天死亡率的危险因素。方法：回顾了2013年12月至2017年5月连续85例行该手术患者的临床资料。进行多因素逻辑回归分析以确定术后PND和30天死亡率的独立预测因素。结果：男性62例，女性23例，平均年龄47.6±11.7岁（范围26 - 73岁）。10例患者（11.76%）术后发生PND。术后30天死亡率为11.76%（10/85），包括住院期间1例死亡和出院后9例死亡。多因素分析显示，高血压与术后PND独立相关（OR = 4.407，95%CI：1.021 - 19.023，P = .047），年龄和术后PND是30天死亡率的独立预测因素（OR分别为1.120；95%CI为1.026 - 1.221；P = .011和OR为7.503；CI为1.290 - 43.634；P = .025）。结论：高血压与术后PND独立相关，年龄和术后PND是行全主动脉弓置换并植入带支架象鼻术患者早期死亡的预测因素。
