Ge Min, Wang Zhigang, Chen Tao, Cheng Yongqing, Ye Jiaxin, Lu Lichong, Chen Cheng, Wang Dongjin
Department of Cardio-thoracic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China.
J Thorac Dis. 2021 Feb;13(2):735-742. doi: 10.21037/jtd-20-2736.
This study aimed to identify risk factors for prolonged mechanical ventilation (PMV) and its association with disease prognosis following acute DeBakey type I aortic dissection surgery.
A total of 582 patients who received emergency surgery for acute DeBakey type I aortic dissection from 2014 to 2018 were enrolled in this study. Mechanical ventilation period after surgery longer than 48 hours was defined as postoperative PMV. Multiple logistic regression analysis was used to identify risk factors for PMV. This study also compared short- and long-term outcomes in patients who developed PMV with patients who did not develop this complication. To identify and compare long-term cumulative survival rate, Kaplan-Meier survival curve was plotted.
Among all enrolled patients, 259 (44.5%) received PMV treatment. Our data suggested that the length of intensive care unit and hospital stay were longer for patients who received PMV treatment. Thirty-day mortality was also higher in patients with PMV than in patients without PMV. Elevated leukocyte count and increased serum cystatin C level upon admission, lower preoperative platelet count and longer cardiopulmonary bypass (CPB) duration were identified as risk factors for PMV. Interestingly, our data suggested that there was no significant difference of survival rate between patients with or without PMV history.
PMV after DeBakey type I aortic dissection repair surgery was a common complication and associated with increased short-term mortality rate but did not affect long-term mortality rate. Elevated preoperative leukocyte count, increased preoperative serum cystatin C level, lower preoperative platelet count and longer CPB duration were risk factors for PMV.
本研究旨在确定急性Ⅰ型主动脉夹层手术后继发长时间机械通气（PMV）的危险因素及其与疾病预后的关系。
本研究纳入了2014年至2018年期间接受急性Ⅰ型主动脉夹层急诊手术的582例患者。术后机械通气时间超过48小时被定义为术后PMV。采用多因素logistic回归分析确定PMV的危险因素。本研究还比较了发生PMV的患者与未发生该并发症的患者的短期和长期结局。为了确定和比较长期累积生存率，绘制了Kaplan-Meier生存曲线。
在所有纳入的患者中，259例（44.5%）接受了PMV治疗。我们的数据表明，接受PMV治疗的患者在重症监护病房的住院时间和住院总时长更长。PMV患者的30天死亡率也高于未发生PMV的患者。入院时白细胞计数升高、血清胱抑素C水平升高、术前血小板计数降低以及体外循环（CPB）时间延长被确定为PMV的危险因素。有趣的是，我们的数据表明，有或无PMV病史的患者生存率无显著差异。
Ⅰ型主动脉夹层修复手术后的PMV是一种常见并发症，与短期死亡率增加相关，但不影响长期死亡率。术前白细胞计数升高、术前血清胱抑素C水平升高、术前血小板计数降低以及CPB时间延长是PMV的危险因素。
