Liang Feng, Su Jie-Qiong
Department of Vascular Surgery, Qinghai Province Cardiovascular and Cerebrovascular Disease Specialist Hospital, Xining 810012, Qinghai Province, China.
Department of Neurology, Qinghai Province Cardiovascular and Cerebrovascular Disease Specialist Hospital, Xining 810012, Qinghai Province, China.
World J Clin Cases. 2024 Aug 6;12(22):4873-4880. doi: 10.12998/wjcc.v12.i22.4873.
BACKGROUND: Aortic dissection is the deadliest disease of the cardiovascular system. Type B aortic dissection accounts for 30%-60% of aortic dissections and is mainly treated by endovascular repair of thoracic endovascular aneurysm repair (TEVAR). However, patients are prone to various complications after surgery, with central nervous system injury being the most common, which seriously affects their prognosis and increases the risk of disability and death. Therefore, exploring the risk factors of central nervous system injury after TEVAR can provide a basis for its prevention and control. AIM: To investigate the risk factors for central nervous system injury after the repair of a thoracic endovascular aneurysm with type B aortic dissection. METHODS: We enrolled 306 patients with type B aortic dissection who underwent TEVAR at our hospital between December 2019 and October 2022. The patients were categorized into injury ( = 159) and non-injury ( = 147) groups based on central nervous system injury following surgery. The risk factors for central nervous system injury after TEVAR for type B aortic dissection were screened by comparing the two groups. Multivariate logistic regression analysis was performed. RESULTS: The Association between age, history of hypertension, blood pH value, surgery, mechanical ventilation, intensive care unit stay, postoperative recovery times on the first day after surgery, and arterial partial pressure of oxygen on the first day after surgery differed substantially ( < 0.05). Multivariate logistic regression analysis indicated that age, surgery time, history of hypertension, duration of mechanical ventilation, and intensive care unit stay were independent risk factors for central nervous system injury after TEVAR of type B aortic dissection ( < 0.05). CONCLUSION: For high-risk patients with central nervous system injury after TEVAR of type B aortic dissection, early intervention measures should be implemented to lower the risk of neurological discomfort following surgery in high-risk patients with central nervous system injury after TEVAR for type B aortic dissection.
背景：主动脉夹层是心血管系统中最致命的疾病。B型主动脉夹层占主动脉夹层的30%-60%，主要通过胸主动脉腔内修复术（TEVAR）进行治疗。然而，患者术后容易出现各种并发症，其中中枢神经系统损伤最为常见，严重影响其预后，增加致残和死亡风险。因此，探究TEVAR术后中枢神经系统损伤的危险因素可为其防治提供依据。 目的：探讨B型主动脉夹层行胸主动脉腔内修复术后中枢神经系统损伤的危险因素。 方法：纳入2019年12月至2022年10月在我院行TEVAR的306例B型主动脉夹层患者。根据术后是否发生中枢神经系统损伤将患者分为损伤组（n = 159）和非损伤组（n = 147）。通过比较两组筛选B型主动脉夹层TEVAR术后中枢神经系统损伤的危险因素。进行多因素logistic回归分析。 结果：年龄、高血压病史、血液pH值、手术、机械通气、重症监护病房停留时间、术后第1天的术后恢复时间以及术后第1天的动脉血氧分压之间的关联存在显著差异（P < 0.05）。多因素logistic回归分析表明，年龄、手术时间、高血压病史、机械通气时间和重症监护病房停留时间是B型主动脉夹层TEVAR术后中枢神经系统损伤的独立危险因素（P < 0.05）。 结论：对于B型主动脉夹层TEVAR术后有中枢神经系统损伤高危风险的患者，应采取早期干预措施，以降低B型主动脉夹层TEVAR术后有中枢神经系统损伤高危风险患者术后神经不适的风险。
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