Department of Anesthesiology, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China.
Cardiovascular Center, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China.
J Invest Surg. 2022 Jul;35(7):1536-1543. doi: 10.1080/08941939.2022.2078022. Epub 2022 May 29.
The aim of the study was to analyze perioperative complications and postoperative mortality in patients of acute Stanford type A aortic dissection(ATAAD)combined with cardiac tamponade (TMP).
In this study, we identified a total of 242 ATAAD patients who underwent surgery from January 2016 to December 2020. Of the 242 patients, 44(18.2%) patients were combined with TMP and 198(81.8%) patients without TMP. We compared perioperative complications and postoperative mortality between the two groups.
The postoperative mortality was significantly higher in patients with TMP (29.5% vs 14.1%, p = 0.014). The incidence of postoperative acute kidney injury (75.0% vs 51.5%, p = 0.005), acute hepatic injury (45.5% vs 20.7%, p = 0.001), cerebral infarction (27.3% vs 13.1%, p = 0.020), low cardiac output syndrome (50.0% vs 33.3%, p = 0.038) and respiratory failure (36.4% vs 22.2%, p = 0.049) in patients with TMP was significantly higher than those without TMP. Binary logistic regression analysis showed that age [odds ratio(OR) 1.063, 95% confidence interval (CI) 1.023∼1.105; p = 0.002], surgical time[odds ratio(OR)1.393, 95% confidence interval (CI) 1.006∼1.929; p = 0.046], cardiac tamponade[odds ratio(OR)3.010, 95% confidence interval (CI) 1.166∼7.767; p = 0.023], circulatory arrest time[odds ratio(OR)1.044, 95% confidence interval (CI) 1.001∼1.088; p = 0.045] were independent risk factors for postoperative mortality in ATAAD patients.
Cardiac tamponade increases the difficulty of perioperative management in ATAAD patients, the incidence of postoperative complications and postoperative mortality, which requires the cooperation of anesthesiologists, intensivists and surgeons to save and improve patients' lives.
本研究旨在分析急性 Stanford 型 A 型主动脉夹层（ATAAD）合并心脏压塞（TMP）患者的围手术期并发症和术后死亡率。
本研究共纳入 2016 年 1 月至 2020 年 12 月期间接受手术的 242 例 ATAAD 患者。其中，44 例（18.2%）患者合并 TMP，198 例（81.8%）患者无 TMP。我们比较了两组患者的围手术期并发症和术后死亡率。
TMP 组的术后死亡率明显更高（29.5% vs. 14.1%，p=0.014）。TMP 组术后急性肾损伤（75.0% vs. 51.5%，p=0.005）、急性肝损伤（45.5% vs. 20.7%，p=0.001）、脑梗死（27.3% vs. 13.1%，p=0.020）、低心输出量综合征（50.0% vs. 33.3%，p=0.038）和呼吸衰竭（36.4% vs. 22.2%，p=0.049）的发生率明显高于无 TMP 组。二元逻辑回归分析显示，年龄[比值比（OR）1.063，95%置信区间（CI）1.023∼1.105；p=0.002]、手术时间[OR 1.393，95%CI 1.006∼1.929；p=0.046]、心脏压塞[OR 3.010，95%CI 1.166∼7.767；p=0.023]、体外循环时间[OR 1.044，95%CI 1.001∼1.088；p=0.045]是 ATAAD 患者术后死亡的独立危险因素。
心脏压塞增加了 ATAAD 患者围手术期管理的难度，增加了术后并发症和死亡率的发生，这需要麻醉师、重症监护医师和外科医生的合作，以挽救和改善患者的生命。
