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目的:识别急性Stanford A型主动脉夹层(ASAAD)术前急性肺损伤(ALI)相关危险因素之间的关系,为评估ALI严重性及探索治疗方法提供科学依据。方法:进行前瞻性单中心临床试验,选取99例进行手术治疗的ASAAD患者。干预指标选取术前临床变量和血清学的检测。主要观察指标用于评估ASAAD患者术前致ALI的独立相关危险因素。ALI以Murray肺损伤评分来定义。结果:有51.5%的患者术前发生了ALI。与术前未患ALI者相比,ALI组患者年龄较大(P=0.037),术后机械通气持续时间较长(P=0.023)。结果显示,PLC[(193±72)vs.(165±65)ng/L,P<0.05],IL-10[(103.4±72.7)vs.(75.1±53.9)ng/L,P<0.05]的浓度ALI组明显低于无ALI组。血浆IL-6的浓度[(57.9±21.7)vs.(69.9±26.3)ng/L,P<0.001)]ALI组明显高于无ALI组。多因素logistic回归分析显示,IL-6(OR=1.022;95%CI:1.001~1.004,P=0.042)和年龄(OR=1.085;95%CI:1.021~1.152,P=0.008)与术前ALI有明显相关性。在这些指标中,IL-6与术前ALI呈正相关性,其临界值为64.76ng/L。结论:以Murray肺损伤评分为标准,51.5%的患者在术前患有ALI。多因素分析显示,术前IL-6水平和年龄是ASAAD患者术前发生ALI的独立危险因素,术前患有ALI的患者年龄普遍较大。IL-6≥64.76 ng/L是非常重要的危险因素并且对于术前发生ALI的ASAAD患者有独立相关性。
Objective: To identify the relationship between acute lung injury (ALI) related risk factors of acute Stanford type A aortic dissection (ASAAD) and to provide a scientific basis for assessing the severity of ALI and exploring the treatment methods. Methods: A prospective single-center clinical trial was conducted in 99 ASAAD patients undergoing surgical treatment. Interventions were selected preoperative clinical variables and serological tests. MAIN OUTCOME MEASURES were used to assess the independent risk factors associated with preoperative ALI in patients with ASAAD. ALI is defined as the Murray lung injury score. Results: ALI occurred in 51.5% of patients before surgery. Patients in the ALI group were older (P = 0.037) and had longer duration of mechanical ventilation (P = 0.023) than those who did not have preoperative ALI. The results showed that the levels of IL-10 [(103.4 ± 72.7) vs. (75.1 ± 53.9) ng / L, P <0.05] The ALI group was significantly lower than the ALI group. Plasma concentrations of IL-6 [(57.9 ± 21.7 vs. 69.9 ± 26.3) ng / L, P <0.001) were significantly higher in the ALI group than those without the ALI group. Multivariate logistic regression analysis showed that IL-6 (OR = 1.022; 95% CI: 1.001-1.004, P = 0.042) and age (OR = 1.085; 95% CI: 1.021-1.1562, P = 0.008) There is a clear correlation. Among these indicators, IL-6 was positively correlated with preoperative ALI, with a cut-off value of 64.76 ng / L. Conclusions: Based on the Murray lung injury score, 51.5% of patients had ALI preoperatively. Multivariate analysis showed that preoperative IL-6 levels and age were independent risk factors for preoperative ALI in patients with ASAAD. Patients with preoperative ALI were generally older. IL-6≥64.76 ng / L is a very important risk factor and has an independent correlation with ASAAD patients with preoperative ALI.