Fan Yongfeng, Liu Xiulun, Li Zhongkui, Xiang Daokang
Department of Cardiac Surgery, Guizhou Provincial People's Hospital, Guizhou, 550499, People's Republic of China.
J Multidiscip Healthc. 2024 Nov 20;17:5353-5362. doi: 10.2147/JMDH.S493917. eCollection 2024.
To investigate the impact of surgical intervention on hemodynamic parameters and postoperative delirium in Stanford Type A aortic dissection patients.
A retrospective analysis was conducted on 139 patients who underwent surgery for Stanford Type A aortic dissection from February 2022 to February 2024. Hemodynamic parameters, including maximum ascending aortic diameter (MAAD), left ventricular end-diastolic diameter (LVEDd), and ejection fraction (LVEF), were compared pre- and post-surgery. Patients were divided into two groups based on delirium occurrence postoperatively: Group A (n=49, with delirium) and Group B (n=90, without delirium). Differences in surgical factors and intensive care conditions were analyzed, and risk factors for postoperative delirium were identified. Group sizes differ due to retrospective categorization based on observed outcomes rather than controlled sampling.
① Hemodynamic parameters: Postoperative MAAD and LVEDd were significantly reduced, while LVEF increased compared to preoperative levels (P < 0.05). ② Surgical and postoperative conditions: Group A had longer surgery, cardiopulmonary bypass, and deep hypothermic circulatory arrest times than Group B (P < 0.05). ③ Univariate analysis of baseline data: Group A had higher rates of patients aged ≥60, hypertension, history of stroke, and elevated preoperative D-dimer levels (P < 0.05). ④ Multivariate logistic analysis: Independent risk factors for postoperative delirium included age ≥60, hypertension, history of stroke, surgery time >6 hours, cardiopulmonary bypass time >3 hours, and deep hypothermic circulatory arrest time >40 minutes (OR > 1, P < 0.05).
Surgical treatment of Stanford Type A aortic dissection has a good effect, significantly improving long-term cardiac function. However, the incidence of postoperative delirium is relatively high and is closely related to factors such as age, hypertension, history of stroke, surgery time, cardiopulmonary bypass time, and deep hypothermic circulatory arrest time.
探讨手术干预对 Stanford A 型主动脉夹层患者血流动力学参数及术后谵妄的影响。
对 2022 年 2 月至 2024 年 2 月期间接受 Stanford A 型主动脉夹层手术的 139 例患者进行回顾性分析。比较手术前后的血流动力学参数，包括升主动脉最大直径（MAAD）、左心室舒张末期直径（LVEDd）和射血分数（LVEF）。根据术后谵妄的发生情况将患者分为两组：A 组（n = 49，发生谵妄）和 B 组（n = 90，未发生谵妄）。分析手术因素和重症监护条件的差异，并确定术后谵妄的危险因素。由于基于观察结果而非对照抽样进行回顾性分类，两组样本量不同。
① 血流动力学参数：与术前水平相比，术后 MAAD 和 LVEDd 显著降低，而 LVEF 升高（P < 0.05）。② 手术及术后情况：A 组的手术时间、体外循环时间和深低温停循环时间均长于 B 组（P < 0.05）。③ 基线数据单因素分析：A 组年龄≥60 岁、高血压、有卒中史及术前 D - 二聚体水平升高的患者比例更高（P < 0.05）。④ 多因素逻辑回归分析：术后谵妄的独立危险因素包括年龄≥60 岁、高血压、有卒中史、手术时间>6 小时、体外循环时间>3 小时和深低温停循环时间>40 分钟（OR > 1，P < 0.05）。
Stanford A 型主动脉夹层的手术治疗效果良好，可显著改善长期心功能。然而，术后谵妄的发生率相对较高，且与年龄、高血压、卒中史、手术时间、体外循环时间和深低温停循环时间等因素密切相关。
