BMI联合术前氧合指数对Stanford A型主动脉夹层术后低氧血症的预测价值
Predictive value of BMI combined with preoperative oxygenation index for postoperative hypoxemia in Stanford type A aortic dissection
- 解放军医学杂志 2023年48卷第12期 页码：1445-1450
- 作者机构：
南方医科大学南方医院心血管外科，广东广州 510515
- 作者简介：
赵金珍，医学硕士，主治医师，主要从事主动脉夹层、动脉粥样硬化与高脂血症方面的研究
郑少忆，E-mail：shaoyizheng@vip.sina.com
- 基金信息：
DOI：10.11855/j.issn.0577-7402.1787.2023.0619
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赵金珍, 吕萍, 朱鹏, 等. BMI联合术前氧合指数对Stanford A型主动脉夹层术后低氧血症的预测价值[J]. 解放军医学杂志, 2023, 48(12): 1445-1450.
Zhao Jin-Zhen,Lv Ping,Zhu Peng,et al.Predictive value of BMI combined with preoperative oxygenation index for postoperative hypoxemia in Stanford type A aortic dissection[J].Medical Journal of Chinese People′s Liberation Army,2023,48(12):1445-1450.
赵金珍, 吕萍, 朱鹏, 等. BMI联合术前氧合指数对Stanford A型主动脉夹层术后低氧血症的预测价值[J]. 解放军医学杂志, 2023, 48(12): 1445-1450. DOI： 10.11855/j.issn.0577-7402.1787.2023.0619.
Zhao Jin-Zhen,Lv Ping,Zhu Peng,et al.Predictive value of BMI combined with preoperative oxygenation index for postoperative hypoxemia in Stanford type A aortic dissection[J].Medical Journal of Chinese People′s Liberation Army,2023,48(12):1445-1450. DOI： 10.11855/j.issn.0577-7402.1787.2023.0619.
摘要
目的,2,探讨Stanford A型主动脉夹层(TAAD)患者术后发生低氧血症的危险因素及其预测价值。,方法,2,收集2018年1月－2021年6月南方医科大学南方医院收治的146例诊断为TAAD并接受孙氏手术的患者进行回顾性分析。根据术后24 h内的氧合指数将患者分为低氧血症组(PaO,2,/FiO,2,≤200 mmHg)与非低氧血症组(PaO,2,/FiO,2,>,200 mmHg)。比较两组患者术前氧合指数、气管插管时间和院内病死率等临床结局的差异，采用多因素logistic回归分析患者术后发生低氧血症的危险因素，并利用受试者工作特征(ROC)曲线分析各危险因素的预测价值。,结果,2,TAAD患者术后低氧血症发生率为45.9%。与非低氧血症组比较，低氧血症组机械通气时间(,P,<,0.001)和ICU停留时间(,P,=0.039)明显延长，且病死率明显增高(,P,=0.011)。多因素logistic回归分析显示，体重指数(BMI)高是TAAD患者术后发生低氧血症的独立危险因素(,OR,=1.701，,P,<,0.001)，而术前氧合指数高是术后低氧血症的保护性因素(,OR,=0.987，,P,=0.004)。ROC曲线分析显示，BMI的曲线下面积(AUC)为0.848，最佳切点为25.8 kg/m,2,，术前氧合指数的AUC为0.808，最佳切点是265 mmHg。,结论,2,BMI,>,25.8 kg/m,2,是TAAD患者术后发生低氧血症的独立危险因素，术前氧合指数,>,265 mmHg的患者术后不易发生低氧血症；术后合并低氧血症的患者气管插管时间更长，院内病死率更高。
Abstract
Objectives,2,To analyze the risk factors and their predictive value for postoperative hypoxemia in Type-A aortic dissection (TAAD).,Methods,2,A single-center retrospective study was conducted among 146 consecutive patients diagnosed as TAAD and undergone aortic arch surgery from January 2018 to June 2021 in Nanfang Hospital of Southern Medical University. According to the lowest postoperative PaO,2,/FiO,2, ratio within 24 hours, the patients were classified into two groups: hypoxemia group (PaO,2,/FiO,2, ≤200 mmHg) and non-hypoxemia group (PaO,2,/FiO,2,>,200 mmHg). The difference of preoperative oxygen index, duration of mechanical ventilation and mortality in hospital were analyzed between the two groups. The independent risk factors for postoperative hypoxemia were evaluated by multivariate logistic regression and the predictive value was analyzed by receiver operator character (ROC) curves.,Results,2,For TAAD patients, the incidence of postoperative hypoxemia was 45.9%. Compared to non-hypoxemia group, hypoxemia group exhibited longer duration of mechanical ventilation (,P,<,0.001) and longer intensive care unit (ICU) length of stay (,P,<,0.05). Moreover, patients with hypoxemia presented higher mortality during hospital (,P,=0.011). Multivariate regression analysis identified BMI as independent risk factor (,OR,=1.701,P,<,0.001) and preoperation PaO,2,/FiO,2, ratio as protective factors for postoperative hypoxemia in patients with TAAD (,OR,=0.987,P,=0.004). Area under the ROC curve of BMI was 0.848, the optimal cut-off point of BMI was 25.8 kg/m,2,. Area under the ROC curve of pre-operation PaO,2,/FiO,2, ratio was 0.808, the optimal cut-off point of preoperation PaO,2,/FiO,2, ratio was 265 mmHg.,Conclusions,2,BMI higher than 25.8 kg/m,2, is an independent risk factor and preoperation PaO,2,/FiO,2, ratio higher than 265 mmHg is a protective factor for postoperative hypoxemia in patients with TAAD. Subjects with hypoxemia had longer duration of mechanical ventilation, ICU stay and higher mortality.
关键词
Stanford A型主动脉夹层术后低氧血症危险因素体重指数
Keywords
type-A aortic dissectionhypoxemiarisk factorsBMI
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