术前血液学参数不足以预测斯坦福A型主动脉夹层修复的死亡率

Selim Durmaz, Ömer Faruk Rahman
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背景:急性A型主动脉夹层的死亡率仍然很高且不可预测。我们的目的是探讨术前血液学指标和可能的危险因素在预测深度低温循环停搏术患者住院死亡率方面的有效性。方法:回顾性分析78例急诊手术患者的临床资料。研究院内死亡的危险因素,建立预测模型。结果:两组患者的人口学资料无统计学差异。在死亡组中,只有术前肌酐水平升高(p < 0.05)。影响死亡率的因素为全循环骤停(TCA)和交叉夹持(X-clamp)次数(p < 0.05)。进行ROC分析以确定预测死亡率的能力并确定分界点。在预测死亡率的ROC分析中,X-Clamp时间> 71分钟,敏感性68.2%,特异性66.1%;TCA > 44.5分钟,敏感性72.7%,特异性73.2%。在死亡组中,这些数值明显高于出院组。结论:在深低温下手术治疗A型主动脉夹层时,血液学生物标志物可能不足以估计死亡风险。关键词:急性;主动脉夹层;生物标志物;死亡率
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Preoperative hematological parameters are inadequate for predicting mortality in Stanford Type A aortic dissection repair
Background: Mortality in acute Type A aortic dissection is still high and unpredictable. We aimed to investigate the validity of preoperative hematological markers and possible risk factors in predicting in-hospital mortality in patients operated with deep hypothermic circulatory arrest method. Methods: 78 consecutive patients who were admitted to the emergency service and operated on were retrospectively analyzed. Risk factors for in-hospital death were investigated to develop a predictive model. Results: There was no difference between patients in terms of the were demographic data of the patients. In the mortality group, only preoperative creatinine levels were found to be higher (p < 0.05). Factors affecting mortality were found as total circulatory arrest (TCA) and cross-clamp (X-clamp) times when intraoperative data were examined (p < 0.05). ROC analysis was performed to determine the power to predict mortality and to determine the cut-off point. In ROC analysis to predict mortality, X-Clamp time > 71 minutes, 68.2% sensitivity and 66.1% specificity, TCA > 44.5 minutes, 72.7% sensitivity and 73.2% specificity were found. In the mortality group, these values were found to be significantly higher than those who were discharged. Conclusion: In the surgical treatment of Type A aortic dissection under deep hypothermia, hematologic biomarkers may be insufficient in estimating the risk for mortality. Keywords: Acute; aortic dissection; biomarker; mortality
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