本特尔手术术后早期并发症风险分析

V.A. Tymoshenko, B.M. Todurov
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引用次数: 0

摘要

目的:探讨本特尔手术后早期并发症的发生频率,并分析患者在重症监护病房(ICU)停留时间延长的可能预测因素。材料和方法。在这项研究中,分析了2012年至2021年间在国家机构“乌克兰卫生部心脏研究所”接受升主动脉瘤本特尔手术的成年患者(18至75岁)的病史。采用单因素和多因素分析(logistic回归)确定预后危险因素。重症监护病房住院时间延长的患者的特点是年龄明显变大(p = 0.005),出现动脉高血压合合症的频率更高(p = 0.044),肾小球滤过率初始值明显降低(p = 0.045)。此外,这些患者使用自体输血装置的可能性高出3.6倍(p = 0.0005),因出血而需要开胸手术的可能性高出近6倍(p = 0.0037)。急性肾功能衰竭发生率为4.3倍(p = 0.0002),急性呼吸衰竭发生率为3.3倍(p = 0.0004)。机械通气时间(OR 1.204 (CI 1.053 ~ 1.377), p = 0.007)和急性肾功能衰竭(OR 4.069 (CI 1.040 ~ 15.923), p = 0.044)是icu患者住院时间延长的独立预测因素。对于有术后ICU住院时间延长危险因素的患者,建议术前和术后采取更积极的治疗策略,以避免可能出现的并发症,缩短住院时间。
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Analysis of the risk of early postoperative complications after Bentall procedure
The aim – to investigate the frequency of early postoperative complications and to analyze possible predictors of the prolonged stay of patients in the intensive care unit (ICU) after Bentall procedure.Materials and methods. In the study, the medical histories of adult patients (from 18 to 75 years old) who underwent Bentall procedure for ascending aortic aneurysm at the State Institution «Heart Institute of the Ministry of Health of Ukraine» between 2012 and 2021 were analyzed. Univariate and multivariate analysis (logistic regression) was used to determine prognostic risk factors.Results. Patients with prolonged stay in intensive care unit were characterized by significantly older age (p = 0.005), more frequent presence of comorbidities of arterial hypertension (p = 0.044) and significantly lower initial values of glomerular filtration rate (p = 0.045). In addition, these patients were 3.6 times more likely (p = 0.0005) to use an autohemotransfusion device and almost 6 times more likely (p = 0.0037) to require rethoracotomy due to bleeding. Acute renal failure was recorded 4.3 times (p = 0.0002) and acute respiratory failure was recorded 3.3 times more often (p = 0.0004). The duration of mechanical ventilation (OR 1.204 (CI 1.053–1.377), p = 0.007) and the development of acute renal failure (OR 4.069 (CI 1.040–15.923), p = 0.044) were two independent predictors of prolonged stay of patients in ICU.Conclusions. For patients with risk factors for a prolonged ICU stay after surgery, more active treatment strategies before and after surgery are recommended to avoid possible complications and shorten hospital stay.
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