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目的回顾性分析深低温停循环全主动脉弓置换术患者的临床资料,探索全主动脉弓置换术后重度全身炎性反应综合征(SIRS)发生的围术期危险因素。方法通过分析我院北楼2013年5月至2015年8月全部深低温停循环下行全主动脉弓置换术患者的临床数据,根据术后48小时内SIRS评分,将患者分为非重度组(N组,SIRS评分≤3分)和重度组(S组,SIRS评分为4分),比较两组患者围术期各项临床指标,计算患者术后重度全身炎性反应综合征的发生率,并通过Logistics回归分析找出该类手术病人术后重度SIRS的围术期危险因素。结果共入选118例患者,男性92例(77.9%),术后有50例(42.4%)发生重度SIRS。与非重度SIRS组相比,重度SIRS组术后ICU停留时间(4.54±3.27d vs2.84±2.46d,P=0.002)及住院时间(11.92±4.68d vs9.93±3.23d,P=0.007)明显延长。多因素logistic回归分析结果显示:术前合并高血压(OR=2.901,95%CI=1.121-7.507,P=0.028)及手术时间(OR=1.006,95%CI=1.001-1.021,P=0.033)是全主动脉弓置换术后发生重度SIRS的独立危险因素。结论深低温停循环下全主动脉弓置换术后重度SIRS的发生率较高(42.4%),并延长患者ICU停留时间及住院时间。术前患有高血压及手术时间是全主动脉弓置换术后重度SIRS发生的独立危险因素。
Objective To retrospectively analyze the clinical data of patients undergoing total aortic arch replacement in deep hypothermic circulatory arrest and explore the perioperative risk factors of severe systemic inflammatory response syndrome (SIRS) after total aortic arch replacement. Methods The clinical data of patients undergoing total aortic arch replacement under deep hypothermic circulatory arrest from May 2013 to August 2015 in our hospital from May 2013 to August 2015 were analyzed. According to the SIRS score within 48 hours after operation, the patients were divided into non-severe group (N group) , SIRS score≤3) and severe group (S group, SIRS score was4). The perioperative clinical indexes of two groups were compared to calculate the incidence of severe systemic inflammatory response syndrome Logistics regression analysis to find out the perioperative risk factors of severe SIRS after operation. Results A total of 118 patients were enrolled, 92 (77.9%) men and 50 (42.4%) patients underwent severe SIRS. The ICU stay time (4.54 ± 3.27d vs 2.84 ± 2.46d, P = 0.002) and hospital stay (11.92 ± 4.68d vs 9.93 ± 3.23d, P = 0.007) in severe SIRS group were significantly higher than those in non-severe SIRS group ) Significantly longer. Multivariate logistic regression analysis showed that preoperative hypertension (OR = 2.901, 95% CI = 1.121-7.507, P = 0.028) and operation time (OR = 1.006,95% CI = 1.001-1.021, P = 0.033) Is an independent risk factor for severe SIRS after total aortic arch replacement. Conclusion The incidence of severe SIRS after total aortic arch replacement under deep hypothermic circulatory arrest is high (42.4%), and prolongation of ICU stay and hospital stay in patients. Preoperative hypertension and operative time are independent risk factors for severe SIRS after total aortic arch replacement.