Sheng Weiyong, Le Sheng, Song Yu, Du Yifan, Wu Jia, Tang Chuanbin, Wang Hongfei, Chen Xing, Wang Su, Luo Jingjing, Li Rui, Xia Jiahong, Huang Xiaofan, Ye Ping, Wu Long, Du Xinling, Wang Dashuai
Department of Emergency General Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Front Cardiovasc Med. 2022 Apr 25;9:851447. doi: 10.3389/fcvm.2022.851447. eCollection 2022.
Hypoxemia is a common complication after Stanford type A acute aortic dissection surgery (AADS), however, few studies about hypoxemia after AADS exist. The aims of this study were to identify independent risk factors for hypoxemia after AADS and to clarify its association with clinical outcomes.
Patients undergoing AADS from 2016 to 2019 in our hospital were identified and used as a training set. Preoperative variables were first screened by univariate analysis and then entered into a multivariate logistic regression analysis to identify independent risk factors. A nomogram and an online risk calculator were constructed based on the logistic model to facilitate clinical practice and was externally validated in an independent dataset.
Severe hypoxemia developed in 119 of the 492 included patients (24.2%) and poorer clinical outcomes were observed in these patients. Five independent risk factors for severe hypoxemia after AADS were identified by multivariate analysis, including older age, smoking history, renal insufficiency, higher body mass index, and white blood cell count. The model showed good calibration, discrimination, and clinical utility in the training set, and was well validated in the validation set. Risk stratification was performed and three risk groups were defined as low, medium, and high risk groups. Hypertension was identified as an independent risk factor for moderate hypoxemia besides the five predictors mentioned above, and renal insufficiency was not significant for mild hypoxemia by multivariate analysis. In addition, although frozen elephant trunk was associated with increased risk of postoperative hypoxemia in the univariate analysis, frozen elephant trunk was also not identified as an independent risk factor for postoperative hypoxemia in the multivariate analysis.
Hypoxemia was frequent following AADS, related to poorer clinical outcomes. Predictors were identified and a nomogram as well as an online risk calculator predicting severe hypoxemia after AADS was developed and validated, which may be helpful for risk estimation and perioperative management.
低氧血症是斯坦福A型急性主动脉夹层手术（AADS）后常见的并发症，然而，关于AADS术后低氧血症的研究较少。本研究旨在确定AADS术后低氧血症的独立危险因素，并阐明其与临床结局的关联。
选取2016年至2019年在我院接受AADS手术的患者作为训练集。术前变量首先通过单因素分析进行筛选，然后纳入多因素逻辑回归分析以确定独立危险因素。基于逻辑模型构建列线图和在线风险计算器以方便临床实践，并在独立数据集中进行外部验证。
492例纳入患者中有119例（24.2%）发生严重低氧血症，这些患者的临床结局较差。多因素分析确定了AADS术后严重低氧血症的五个独立危险因素，包括年龄较大、吸烟史、肾功能不全、较高的体重指数和白细胞计数。该模型在训练集中显示出良好的校准、区分度和临床实用性，并在验证集中得到了很好的验证。进行了风险分层，定义了三个风险组，即低、中、高风险组。除上述五个预测因素外，高血压被确定为中度低氧血症的独立危险因素，多因素分析显示肾功能不全对轻度低氧血症无显著影响。此外，虽然在单因素分析中“象鼻”技术与术后低氧血症风险增加相关，但在多因素分析中“象鼻”技术也未被确定为术后低氧血症的独立危险因素。
AADS术后低氧血症很常见，与较差的临床结局相关。确定了预测因素，并开发并验证了预测AADS术后严重低氧血症的列线图和在线风险计算器，这可能有助于风险评估和围手术期管理。
