本文選題：胸部主動脈 + 血管置換�。� 參考：《寧夏醫(yī)科大學》2015年碩士論文

【摘要】：目的本研究通過觀察我科107例胸部主動脈血管疾病的患者的手術(shù)治療效果,收集臨床資料,進行回顧性研究,分析接受外科手術(shù)治療的胸部主動脈血管疾病的患者圍術(shù)期的危險因素,總結(jié)并歸納,以期為臨床未來的治療起到一定的參考作用。方法1.篩選2005年1月至2014年6月期間于寧夏醫(yī)科大學總醫(yī)院心臟中心大血管外科的胸部主動脈疾病的患者(包括升主動脈瘤、馬凡綜合癥、Stanford A型主動脈夾層等)的臨床資料共107例為研究總體進行回顧性分析。2.收集我科接受手術(shù)治療的胸主動脈疾病患者的臨床資料,分為兩大組:未涉及主動脈弓部手術(shù)組:年齡、性別、心功能NYHA分級、高血壓病史、冠心病病史、吸煙史、主動脈直徑、術(shù)前EF值、手術(shù)時間、CPB時間、ACC時間、同期手術(shù)、術(shù)后氣管插管輔助呼吸時間、術(shù)后12小時引流量、術(shù)后ICU停留時間;涉及主動脈弓部手術(shù)組:年齡、性別、高血壓病史、吸煙史、手術(shù)期限、術(shù)前腎功能不全、手術(shù)時間、CPB時間、ACC時間、停循環(huán)時間、術(shù)后氣管插管輔助呼吸時間、術(shù)后ICU停留時間。3.使用SPSS 18.0對資料進行單因素分析,然后采用Logistic回歸對與死亡相關(guān)的具有統(tǒng)計意義的單因素進行多因素分析,篩選出具有統(tǒng)計意義的獨立危險因素。4.對本研究中得出的結(jié)果進行歸納總結(jié)。結(jié)果1.未涉及主動脈弓部手術(shù)組共73例,死亡率是9.6%(7/73),與死亡相關(guān)的主要因素有:年齡大于60歲,吸煙,EF值50%,手術(shù)時間≥310min,ACC時間≥120min,CPB時間≥180min,術(shù)后12h引流量≥560ml,呼吸機輔助呼吸時間≥65小時,監(jiān)護室停留時間≥90小時。涉及主動脈弓部手術(shù)組共34例,死亡率是:26.5%(9/34),與死亡相關(guān)的主要因素有:性別,術(shù)前腎功能不全,急診手術(shù),CPB時間≥180min,ACC時間≥120min。2.采用Logistic回歸對單因素進行多因素分析,未涉及主動脈弓部手術(shù)組與死亡相關(guān)的獨立危險因素為:CPB時間,呼吸機輔助時間;涉及主動脈弓部手術(shù)組與死亡相關(guān)的獨立危險因素為:術(shù)前腎功能不全,ACC時間。結(jié)論1.CPB時間≥180min及呼吸機輔助呼吸時間≥65h是未涉及主動脈弓部的胸部主動脈血管置換手術(shù)預測術(shù)后早期死亡的獨立危險因素。2.術(shù)前腎功能不全及ACC時間≥120min是涉及主動脈弓部的胸部主動脈血管置換手術(shù)預測術(shù)后早期死亡的獨立危險因素。3.本研究為單中心研究,樣本量較小,臨床數(shù)據(jù)存在部分缺失,對研究的最終結(jié)果可能會產(chǎn)生一定的影響,討論不夠全面,仍需長期觀察并驗證。
[Abstract]:Objective to study the clinical data of 107 patients with thoracic aortic vascular disease in our department. The perioperative risk factors of patients with thoracic aortic vascular diseases undergoing surgical treatment were analyzed, summarized and summarized in order to serve as a reference for future clinical treatment. Method 1. Screening of patients (including ascending aortic aneurysms) with thoracic aortic diseases (including ascending aortic aneurysms) from January 2005 to June 2014 in the Department of Cardiovascular surgery, Cardiac Center, General Hospital of Ningxia Medical University, The clinical data of 107 patients with Marfan's syndrome (Stanford A aortic dissection et al.) were analyzed retrospectively. The clinical data of patients with thoracic aortic disease undergoing surgical treatment were collected and divided into two groups: age, sex, NYHA classification of cardiac function, history of hypertension, history of coronary heart disease, and history of smoking. Aortic diameter, preoperative EF, CPB time and ACC time, simultaneous operation, tracheal intubation assisted respiration time, postoperative 12 hours drainage, postoperative ICU stay time, involved aortic arch operation group: age, sex, History of hypertension, history of smoking, duration of operation, preoperative renal insufficiency, CPB time, ACC time, circulatory arrest time, tracheal intubation assisted respiration time, postoperative ICU stay time. SPSS 18.0 was used for univariate analysis, and logistic regression was used for multivariate analysis of the statistical single factor associated with death. The independent risk factors with statistical significance were screened out. 4. The results of this study are summarized. Result 1. There were 73 cases in the group not involved in aortic arch surgery. The mortality rate was 9.67% of 73%. The main factors associated with death were: age over 60 years old. The EF value of smoking was 50%, the operation time 鈮，

本文編號：2032497