Department of Anesthesiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China.
Department of Anesthesiology, Jiangxi Provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, China.
Medicine (Baltimore). 2023 Sep 29;102(39):e34668. doi: 10.1097/MD.0000000000034668.
Postoperative pulmonary complications (PPCs) are among the most common complications after cardiovascular surgery. This study aimed to explore the real incidence of and risk factors for PPC in patients with acute type A aortic dissection (ATAAD) who underwent total aortic arch replacement combined with the frozen elephant trunk (TAR + FET). In total, 305 ATAAD patients undergoing TAR + FET from January 2021 to August 2022 in a single-center were divided into PPCs or non-PPCs group. The incidence of PPCs was calculated, risk factors of PPCs were analyzed, and postoperative outcomes were compared between these 2 groups. The incidence of any PPC was 29.2%. And the incidence of respiratory infection, respiratory failure, pleural effusion, atelectasis, pneumothorax, acute respiratory distress syndrome, aspiration pneumonitis, pulmonary edema and bronchospasm was 23.0%, 12.5%, 10.5%, 1.0%, 0.7%, 1.0%, 0%, 0.7%, 0%, respectively. The logistic regression analysis revealed that the history of diabetes, history of renal dysfunction, preoperative SpO2 <90%, cardiopulmonary bypass duration, fresh frozen plasma volume and platelet concentrates volume were independent risk factors for PPCs. Among 2 groups, postoperative ventilation duration, postoperative length of stay in intensive care unit and hospital were (73.5 ± 79.0 vs 24.8 ± 35.2 hours; P < .001), (228.3 ± 151.2 vs 95.2 ± 72.0 hours; P < .001) and (17.9 ± 8.8 vs 11.5 ± 6.2 days; P < .001). There was no difference between 2 groups of in-hospital mortality rate. Additionally, other short-term outcomes were also significantly poorer in patients with PPCs. PPCs are common in ATAAD patients undergoing TAR + FET, and could be multifactorial. PPCs occurrence are associated with poor patient outcomes postoperatively and worth further investigation.
术后肺部并发症（PPCs）是心血管手术后最常见的并发症之一。本研究旨在探讨行全主动脉弓置换联合冷冻象鼻（TAR+FET）的急性A型主动脉夹层（ATAAD）患者 PPC 的真实发生率和危险因素。2021 年 1 月至 2022 年 8 月，在单中心行 TAR+FET 的 305 例 ATAAD 患者被分为 PPC 或非 PPC 组。计算 PPC 的发生率，分析 PPC 的危险因素，并比较两组术后结局。任何 PPC 的发生率为 29.2%。呼吸感染、呼吸衰竭、胸腔积液、肺不张、气胸、急性呼吸窘迫综合征、吸入性肺炎、肺水肿和支气管痉挛的发生率分别为 23.0%、12.5%、10.5%、1.0%、0.7%、1.0%、0%、0.7%和 0%。logistic 回归分析显示，糖尿病史、肾功能不全史、术前 SpO2<90%、体外循环时间、新鲜冰冻血浆量和血小板浓缩物量是 PPC 的独立危险因素。两组患者术后通气时间、术后 ICU 入住时间和住院时间分别为（73.5±79.0 比 24.8±35.2 小时；P<0.001）、（228.3±151.2 比 95.2±72.0 小时；P<0.001）和（17.9±8.8 比 11.5±6.2 天；P<0.001）。两组住院死亡率无差异。此外，PPC 患者的其他短期结局也明显较差。PPCs 在接受 TAR+FET 的 ATAAD 患者中较为常见，可能是多因素引起的。PPCs 的发生与术后患者预后不良有关，值得进一步研究。
