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目的分析高血压对主动脉夹层患者术后早期中枢神经系统功能的影响。方法选取南京鼓楼医院2008-11-2011-05主动脉夹层术后患者(n=77),根据是否有中枢神经系统损伤分为损伤组(n=35)和对照组(n=42),应用单因素和多因素Logistic回归分析高血压对主动脉夹层患者术后早期中枢神经系统功能的影响。结果与对照组比较,损伤组高血压患者的比率[80%(28/35)比45%(19/42),P<0.05]、术中失血量[(5037.1±3888.1)比(2466.7±2194.2)mL,P<0.01]升高,术后24h内尿量[(1092.9±727.2)比(1399.3±510.5)mL]、术后回重症加强护理病房(ICU)第一次血气分析pH值[(7.39±0.10)比(7.44±0.08)]、术后回ICU第一次血气分析的动脉血氧分压(PaO2)值[(81.8±30.7)比(116.1±56.9)mmHg,均P<0.05]降低。单因素分析表明高血压史、术中失血量、术后24h内尿量、术后回ICU第一次血气分析的pH值、术后回ICU第一次血气分析的PaO2值可明显影响中枢神经系统功能的恢复;多因素分析表明高血压史(OR0.196)及术后回ICU第一次血气分析PaO2值(OR1.015)是影响中枢神经系统功能恢复的独立危险因素。结论高血压是影响主动脉夹层患者术后早期中枢神经系统功能恢复的独立危险因素。
Objective To analyze the effect of hypertension on early postoperative central nervous system function in patients with aortic dissection. Methods The patients with aortic dissection (n = 77) were randomly divided into injury group (n = 35) and control group (n = 42) according to whether there was central nervous system injury. Influence of Hypertension on Early Central Nervous System Function in Patients with Aortic Dissection after Univariate and Multivariate Logistic Regression. Results Compared with the control group, the rate of blood loss in the injury group was significantly higher than that in the control group (80% (28/35) vs 45% (19/42), P <0.05], and the intraoperative blood loss was (5037.1 ± 3888.1) (2466.7 ± 2194.2) ), P <0.01], and the urinary output within 24h after operation ((1092.9 ± 727.2) vs (1399.3 ± 510.5) mL] and the first blood gas analysis of Intensive Care Unit (ICU) (P <0.05), the mean value of PaO2 was (81.8 ± 30.7) and (116.1 ± 56.9) mmHg in the first ICU blood gas analysis after operation compared with that of the control group (7.39 ± 0.10 vs 7.44 ± 0.08) reduce. Univariate analysis showed that history of hypertension, intraoperative blood loss, intraoperative 24h urine output, postoperative ICU blood gas analysis of the first return to the ICU after the first blood gas analysis PaO2 value can significantly affect the central nervous system (OR0.196) and the first blood gas analysis PaO2 value (OR1.015) back to the ICU postoperatively were the independent risk factors affecting the recovery of central nervous system function. Conclusion Hypertension is an independent risk factor affecting the recovery of central nervous system function in patients with aortic dissection.