Department of Cardiac Surgery, Beijing Aortic Disease Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
Beijing Advanced Innovation Center for Big Data-Based Precision Medicine, Capital Medical University, Beijing, China.
Exp Physiol. 2023 May;108(5):683-691. doi: 10.1113/EP091054. Epub 2023 Mar 19.
What is the central question of this study? Hypoxaemia can lead to increased postoperative mortality in patients: what are the independent risk factors for severe hypoxaemia after acute Stanford type A aortic dissection? What is the main finding and its importance? Severe postoperative hypoxaemia was found in 36.4% of patients, and it was determined that high preoperative bradykinin levels and increased BMI were independent predictors of severe postoperative hypoxaemia in patients with acute Stanford type A aortic dissection. For obese patients with high preoperative bradykinin levels, more attention should be paid to preventing severe postoperative hypoxaemia.
Severe hypoxaemia after cardiac surgery is associated with serious complications and a high risk of mortality. The purpose of this study is to investigate the independent risk factors of severe postoperative hypoxaemia in patients with acute Stanford type A aortic dissection. We collected 77 patients with acute Stanford type A aortic dissection who underwent surgical treatment. The primary outcome was severe postoperative hypoxaemia (PaO /FiO ≤ 100 mmHg), and a multivariate logistic regression analysis was performed to assess the independent predictors of risk for this. A mixed-effects analysis of variance model and a receiver operating characteristic (ROC) curve were generated to evaluate the predictive probabilities of risk factors for severe postoperative hypoxaemia. A total of 36.4% of patients developed severe postoperative hypoxaemia. The multivariate logistic regression analysis identified high preoperative bradykinin level (odds ratio (OR) = 55.918, P < 0.001) and increased body mass index (BMI; OR = 1.292, P = 0.032) as independent predictors of severe postoperative hypoxaemia in patients with acute Stanford type A aortic dissection. The mixed-effect analysis of variance model and ROC curve indicated that high preoperative bradykinin level and BMI were significant predictors of severe postoperative hypoxaemia (area under the ROC curve = 0.834 and 0.764, respectively). High preoperative bradykinin levels and obesity were independent risk factors for severe postoperative hypoxaemia in patients with acute Stanford type A aortic dissection. For obese patients with high levels of bradykinin before surgery, clinicians should actively take measures to block bradykinin-mediated inflammatory reactions.
本研究的核心问题是什么？低氧血症可导致急性 Stanford 型 A 型主动脉夹层患者术后死亡率增加：急性 Stanford 型 A 型主动脉夹层患者术后严重低氧血症的独立危险因素有哪些？主要发现及其重要性是什么？36.4%的患者术后出现严重低氧血症，确定术前高缓激肽水平和 BMI 增加是急性 Stanford 型 A 型主动脉夹层患者术后严重低氧血症的独立预测因素。对于术前缓激肽水平高的肥胖患者，应更加注意预防术后严重低氧血症。
心脏手术后严重低氧血症与严重并发症和高死亡率相关。本研究旨在探讨急性 Stanford 型 A 型主动脉夹层患者术后严重低氧血症的独立危险因素。我们收集了 77 例接受手术治疗的急性 Stanford 型 A 型主动脉夹层患者。主要结局为术后严重低氧血症（PaO /FiO ≤ 100mmHg），并进行多变量逻辑回归分析以评估风险的独立预测因素。生成混合效应方差分析模型和受试者工作特征（ROC）曲线以评估术后严重低氧血症风险因素的预测概率。共有 36.4%的患者发生术后严重低氧血症。多变量逻辑回归分析确定术前高缓激肽水平（优势比（OR）=55.918，P<0.001）和 BMI 增加（OR=1.292，P=0.032）是急性 Stanford 型 A 型主动脉夹层患者术后严重低氧血症的独立预测因素。混合效应方差分析模型和 ROC 曲线表明，术前高缓激肽水平和 BMI 是术后严重低氧血症的显著预测因素（ROC 曲线下面积分别为 0.834 和 0.764）。术前高缓激肽水平和肥胖是急性 Stanford 型 A 型主动脉夹层患者术后严重低氧血症的独立危险因素。对于术前缓激肽水平高且肥胖的患者，临床医生应积极采取措施阻断缓激肽介导的炎症反应。
