Wang Y, Sun M H, Niu Z Z, Li Y T, Gao X, Li M, Zhang W F, Sheng W, Wang T Y, Li H Y, Wang J X, Wang Z B, Wu J T
Department of Otorhinolaryngology Head and Neck Surgery, Qingdao Municipal Hospital, Medical College of Qingdao University, Qingdao 266071, China.
Department of Cardiovascular, Qingdao Municipal Hospital, Medical College of Qingdao University, Qingdao 266071, China.
Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2021 May 7;56(5):447-453. doi: 10.3760/cma.j.cn115330-20200716-00596.
To confirm the impact of obstructive sleep apnea hypopnea syndrome (OSAHS) on perioperative and long-term outcome in patients with Stanford type A aortic dissection. From June 2010 to July 2017, the clinical data of 91 patients with Stanford type A aortic dissection were analyzed. Among them, 51 patients with OSAHS were included in the study group and 40 patients without OSAHS were included in the control group. After 36 months follow-up, all-cause death was regarded as the end event. The clinical baseline data, perioperative period and 36 months survival rate of the two groups were compared. Kanplan-Meier method was used to describe the 36 month survival curve of the two groups. Cox proportional risk model was used to evaluate the risk ratio (HR) and 95%CI of 36 month survival rate. The mortality rate during hospitalization was 5.9% (3 cases) in the study group and 5.0% (2 cases) in the control group, and the difference was not statistically significant (χ2=0.03, >0.05). The actual follow-up was (36.2±1.5) months, 88 cases were followed up and 3 cases were lost. The all cause mortality rate of 36 months was 27.5% (14/51)in the study group and 10.0%(4/40) in the control group, the difference was statistically significant (χ2=4.30, <0.05).By Cox proportional risk model analysis, 36 months after operation, the study group was compared with the control group after adjusting for age, male, bicuspid of aortic valve, chronic obstructive pulmonary disease, anemia, preoperative pericardial tamponade, postoperative organ dysfunction, preoperative LVEF, emergency operation, Sun's operation, coronary artery bypass grafting, hypertension, cardiac arrhythmia, and advanced avulsion of distal aortic dissection The survival rate was lower, the difference was statistically significant (<0.05).In addition to OSAHS, coronary artery bypass grafting and preoperative pericardial tamponade were also risk factors for the increase of 36 month mortality rate (HR=11.28,95%: 1.98-46.25, 0.009; HR=9.08, 95%: 2.22-41.3, 0.032). There was no significant difference in mortality during hospitalization in patients with Stanford A aortic dissection combined with OSAHS. The survival rate of 36 months after operation was lower than that of the control group.
为证实阻塞性睡眠呼吸暂停低通气综合征（OSAHS）对斯坦福A型主动脉夹层患者围手术期及长期预后的影响。回顾性分析2010年6月至2017年7月收治的91例斯坦福A型主动脉夹层患者的临床资料，根据是否合并OSAHS分为研究组51例和对照组40例。随访36个月，以全因死亡为观察终点，比较两组临床基线资料、围手术期情况及36个月生存率。采用Kaplan-Meier法绘制两组36个月生存曲线，Cox比例风险模型评估36个月生存率的风险比（HR）及95%可信区间（CI）。结果显示，研究组住院死亡率为5.9%（3例），对照组为5.0%（2例），差异无统计学意义（χ2=0.03，P>0.05）。实际随访（36.2±1.5）个月，失访3例，共随访88例。研究组36个月全因死亡率为27.5%（14/51），对照组为10.0%（4/40），差异有统计学意义（χ2=4.30，P<0.05）。Cox比例风险模型分析显示，术后36个月，校正年龄、男性、主动脉瓣二瓣化、慢性阻塞性肺疾病、贫血、术前心包填塞、术后器官功能障碍、术前左心室射血分数、急诊手术、孙氏手术、冠状动脉旁路移植术、高血压及心律失常、主动脉夹层远端严重撕裂等因素后，研究组生存率低于对照组，差异有统计学意义（P<0.05）。此外OSAHS、冠状动脉旁路移植术及术前心包填塞是36个月死亡率增加的危险因素（HR=11.28，95%CI：1.9846.25，P=0.009；HR=9.08，95%CI：2.2241.3，P=0.032）。结论：斯坦福A型主动脉夹层合并OSAHS患者住院死亡率无明显差异，但术后36个月生存率低于对照组。
