胸主动脉腔内修复术后全身炎症反应综合征的危险因素分析

向军; 何玲; 李东林; 彭泰峦; 魏蜀亮

doi:10.13201/j.issn.1001-1439.2021.05.015

胸主动脉腔内修复术后全身炎症反应综合征的危险因素分析

- 1. 川北医学院附属医院心脏大血管外科(四川南充,637000);
- 2. 川北医学院附属医院儿科

详细信息

通讯作者: 魏蜀亮,E-mail:shuliang_wei@163.com

中图分类号: R543

收稿日期: 2020-10-30

Analysis of risk factors for systemic inflammatory response syndrome after thoracic endovascular aortic repair

- 1. Department of Cardiovascular Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, 637000, China;
- 2. Department of Paediatrics, Affiliated Hospital of North Sichuan Medical College

More Information

Corresponding author: WEI Shuliang, E-mail: shuliang_wei@163.com

Received Date: 30 October 2020

摘要

摘要: 目的:探讨胸主动脉腔内修复(TEVAR)术后全身炎症反应综合征(SIRS)的相关危险因素,及SIRS的管理策略。方法:连续收集2013年2月—2019年10月川北医学院附属医院心脏大血管外科251例Stanford B型急性主动脉综合征(AAS)患者的临床资料,其中男187例,女64例;所有患者均在全麻介入下行TEVAR手术,按照术后是否发生SIRS分为SIRS组和非SIRS组,分别记录2组患者术前、术中相关指标及术后并发症;将单因素分析具有统计学意义的变量进行多因素Logistic回归分析,进一步明确TEVAR术后SIRS的危险因素;同时比较2组患者并发症情况。结果:TEVAR术后SIRS发生率约为31.47%。多因素分析结果显示:糖尿病史(OR=2.036,95%CI:1.019~3.254,P=0.024)、胸腔积液(OR=1.962,95%CI:1.261~5.037,P=0.018)、术前中性粒细胞/淋巴细胞比值(NLR)(OR=2.841,95%CI:0.951~2.685,P=0.009)、D-二聚体(OR=3.128,95%CI:1.024~4.392,P=0.013)、降主动脉直径(OR=1.869,95%CI:0.793~5.174,P=0.031)是TEVAR术后SIRS的独立危险因素。SIRS组患者术后肺损伤(24.1%∶5.8%,P<0.001)、肺部感染(30.4%∶11.6%,P<0.001)、二次气管插管(6.3%∶1.2%,P=0.021)、气管切开(3.8%∶0.6%,P=0.002)发生率明显增高,机械通气时间[(7.51±4.38) h∶(3.43±2.71) h,P<0.001]、术后ICU停留时间[(3.18±2.95) d∶(1.32±1.15) d,P<0.001]、住院时间[(12.31±8.51) d∶(9.15±8.46) d,P=0.006]均明显延长,院内死亡率(6.3%∶1.2%,P=0.021)增加。结论:TEVAR术后SIRS发生率较高,糖尿病史、胸腔积液、术前NLR、D-二聚体、降主动脉直径是TEVAR术后SIRS的独立危险因素。SIRS与术后肺部并发症发生率、死亡率增加及住院时间延长显著相关。因此,应更加注重TEVAR术后SIRS的危险因素,针对危险因素优化治疗策略以减少SIRS的发生以改善预后。
- 急性主动脉综合征 /
- 胸主动脉腔内修复术 /
- 全身炎症反应综合征 /
- 危险因素
Abstract: Objective: To analyze the independent risk factors and complications for systemic inflammatory response syndrome(SIRS) after thoracic endovascular aortic repair(TEVAR) and investigate the management strategy of SIRS.Methods: There were 251 cases of patients with type Stanford B acute aortic syndrome(AAS) underwent operation in this study, including187 male and 64 female. All the patients underwent TEVAR under general anesthesia. According to whether had SIRS, patients were divided into 2 groups: SIRS goup and non-SIRS group. Univariate and logistic regression analysis were used to identify the independent risk factors. The perioperative complications were also recorded.Results: The incidence of SIRS after TEVAR was about 31.47%. The history of diabetes(OR=2.036, 95%CI: 1.019-3.254, P=0.024), pleural effusion(OR=1.962, 95%CI: 1.261-5.037, P=0.018), neutrophil/lymphocyte ratio(OR=2.841, 95%CI: 0.951-2.685, P=0.009), D-dimer(OR=3.128, 95%CI: 1.024-4.392, P=0.013), descending aorta diameter(OR=1.869, 95%CI: 0.793-5.174, P=0.031) were the independent risk factors for SIRS after TEVAR. The incidence rate of postoperative pulmonary failure(24.1% vs. 5.8%, P<0.001), pulmonary infection(30.4% vs. 11.6%, P<0.001), re-intubation(6.3% vs. 1.2%, P=0.021) and tracheotomy(3.8% vs. 0.6%, P=0.002) in SIRS group were significantly increase. The duration of mechanical ventilation[(7.51±4.38) hours vs.(3.43±2.71) hours, P<0.001], ICU stay time[(3.18±2.95) days vs.(1.32±1.15) days, P<0.001]and hospitalization time[(12.31±8.51) days vs. 9.15±8.46) days, P=0.006]were significantly prolonged. The perioperative mortality(6.3% vs. 1.2%, P=0.021) was significantly increased.Conclusion: The history of diabetes, pleural effusion, neutrophil/lymphocyte ratio, D-dimer, descending aorta diameter were the independent risk factors for postoperative SIRS after TEVAR. The perioperative complications in SIRS group were significantly increased.
- acute aortic syndrome /
- thoracic endovascular aortic repair /
- systemic inflammatory response syndrome /
- risk factors

HTML全文

参考文献(23)

[1]	Carroll BJ,Schermerhorn ML,Manning WJ,et al.Imaging for acute aortic syndromes[J].Heart,2020,106(3):182-189.
[2]	Cochennec F,Marzelle J.Acute aortic syndromes[J].Presse Med,2018,47(2),140-152.
[3]	Bossone E,Ranieri B,Romano L,et al.Acute aortic syndromes:diagnostic and therapeutic pathways[J].Heart Fail Clin,2020,16(3):305-315.
[4]	Murphy MC,Castner CF,Kouchoukos NT.Acute Aortic Syndromes:Diagnosis and Treatment[J].Mo Med,2017,114(6):458-463.
[5]	Akowuah E,Wilde P,Angelini G,et al.Systemic inflammatory response after endoluminal stenting of the descending thoracic aorta[J].Interact Cardiovasc Thorac Surg,2007,6(6):41-43.
[6]	向军,何玲,彭慧,等.急性创伤性Stanford B型主动脉夹层的早期诊断及腔内修复治疗[J].中华急诊医学杂志,2020(5):726-730.
[7]	He Z,Tang F,Lei H,et al.Risk factors for systemic inflammatory response syndrome after percutaneous nephrolithotomy[J].Prog Urol,2018,28(12):582-587.
[8]	Squiccimarro E,Labriola C,Malvindi PG,et al.Prevalence and clinical impact of systemic inflammatory reaction after cardiac surgery[J].Journal of Cardiothoracic and Vascular Anesthesia,2019,33(6):1682-1690.
[9]	Massara M,Alberti A,Volpe P.Early and mid-term results of endovascular treatment of thoracic aorta diseases:a single-center experience[J].Semin Vasc Surg,2020,32:111-116.
[10]	Gorla R,Erbel R,Eagle K A,et al.Systemic inflammatory response syndromes in the era of interventional cardiology[J].Vascular Pharmacology,2018:S153718911830020X.
[11]	张韬,熊江,贾鑫,等.主动脉瘤腔内治疗术后全身炎症反应综合征的风险因素研究[J].中华普通外科杂志,2012,40(12):992-995.
[12]	Lojanapiwat B,Kitirattrakarn P.Role of preoperative and intraoperative factors in mediating infection complication following percutaneous nephrolithotomy[J].Urol Int,2011,86(4):448-452.
[13]	向军,何玲,刘艳,等.成人心内直视手术后肺部感染病原菌及相关因素分析[J].重庆医学,2020,49(3):416-420.
[14]	Genoni M,Paul M,Tavakoli R,et al.Predictors of complications in acute type B aortic dissection[J].Eur J Cardiothorac Surg,2002,22(1):59-63.
[15]	Riccardo G,Raimund E,Philipp K,et al.Clinical features and prognostic value of stent-graft-induced post-implantation syndrome after thoracic endovascular aortic repair in patients with type B acute aortic syndromes[J].Eur J Cardio-Thoracic Surgery,2015,1239:120-130.
[16]	Lee JH,Choi JH,Kim EJ.Volume of mural thrombus plays a role in the elevation of inflammatory markers after endovascular aortic repair[J].J Cardiothoracic Surgery,2018,13(1):27-27.
[17]	Nazerian P,Mueller C,Soeiro AM,et al.Diagnostic accuracy of the aortic dissection detection risk Score plus D-dimer for acute aortic ayndromes:The ADvISED Prospective Multicenter Study[J].Circulation,2018,137(3),250-258.
[18]	Eggebrecht H,Mehta RH,Metozounve H,et al.Clinical implications of systemic inflammatory response syndrome following thoracic aortic stent-graft placement[J].J Endovascular Therapy,2008,15(2):135-143.
[19]	黄丽,齐洁,崔建国,等.中性粒细胞/淋巴细胞比值与慢性心力衰竭急性发作患者院内死亡的相关性研究[J].临床心血管病杂志,2020,36(2):138-142.
[20]	陈晨,陶向宏,许晓蓉,等.中性粒细胞与淋巴细胞比值与脓毒症患者急性肾损伤发生的相关性[J].临床急诊杂志,2020,21(7):530-534+540.
[21]	Li J,Yang L,Wang G,et al.Severe systemic inflammatory response syndrome in patients following Total aortic arch replacement with deep hypothermic circulatory arrest[J].J Cardiothorac Surg,2019,14(1):217-219.
[22]	Arnaoutoglou E,Kouvelos G,Papa N,et al.Prospective evaluation of post-implantation inflammatory response after EVAR for AAA:influence on patients' 30 day outcome[J].Eur J Vasc Endovasc Surg,2015,49(2):175-183.
[23]	向军,何玲,舒凯森,等.儿童先天性心脏病术后低心排综合征的危险因素分析[J].临床心血管病杂志,2020,36(6):554-558.