术前MELD分级对304例急性StandfordA型主动脉夹层患者术后早期结局的影响

doi:10.6040/j.issn.1671-7554.0.2022.1049

摘要/Abstract

摘要： 目的分析术前不同终末期肝病模型(MELD)评分对急性Stanford A型主动脉夹层患者行手术治疗后早期死亡及术后并发症发生的影响,探究术后早期死亡的危险因素。方法回顾性分析2018年1月至2021年12月在山东大学齐鲁医院心血管外科接受手术治疗的急性Stanford A型主动脉夹层患者304例的临床资料。根据术前MELD评分评价肝功能,将患者分为低MELD组(n=204例,MELD<10)、中MELD组(n=72例,10≤MELD<15)和高MELD组(n=28例,MELD≥15)。比较各组间一般资料和围术期临床资料。采用Cox回归分析术前MELD及其他因素对患者生存结局的影响。结果共纳入304例患者,63例(20.7%)患者在术后早期死亡。术前MELD水平较高的患者术后早期死亡率(P<0.001)和主要不良临床事件(MACE)的发生率(P=0.007)明显较高。多因素Cox回归显示,术前MELD≥15与住院死亡率独立相关。结论术前MELD增高即肝功能下降显著增加了急性StanfordA型主动脉夹层患者的术后早期死亡率和不良并发症的发生率。术前MELD评分有助于对患者进行风险分层,进而对高危患者进行早期预防和干预,以改善患者预后。

关键词: 终末期肝病模型, 肝功能, 急性A型主动脉夹层, 术后结局, 危险因素

Abstract: Objective To analyze the effects of different preoperative model for end-stage liver disease(MELD)scores on the early death and postoperative complications in patients with acute Stanford type A aortic dissection(ATAAD)undergoing surgical treatment, and to explore the risk factors of early postoperative death. Methods The clinical data of 304 ATAAD patients who received surgery during Jan. 2018 and Dec. 2021 were retrospectively analyzed. According to the preoperative MELD score, the patients were divided into three groups: low MELD group(n=204, MELD <10), medium MELD group(n=72, 10≤MELD<15)and high MELD group(n=28, MELD≥15). The general data and perioperative clinical data were compared among the groups. Effects of preoperative MELD scores and other factors on the survival were determined with Cox regression analysis. Results Of the 304 patients enrolled, 63(20.7%)died in the early postoperative period. Patients with higher preoperative MELD score had significantly higher rate of mortality(P<0.001)and major adverse clinical events(MACEs)(P=0.007). Multivariate Cox regression showed that preoperative MELD ≥15 was independently associated with in-hospital mortality. Conclusion Increased preoperative MELD score and decreased liver function significantly increase early postoperative mortality and MACEs in patients with ATAAD. Preoperative MELD score is helpful for risk stratification of patients, and early prevention and intervention of high-risk patients can help improve the prognosis.

Key words: Model for end-stage liver disease, Liver function, Acute Stanford type A aortic dissection, Postoperative outcome, Risk factors

中图分类号:

R654

宋晗,王振华,韦铎亮,徐凯,李博文,赵鑫. 术前MELD分级对304例急性StandfordA型主动脉夹层患者术后早期结局的影响[J]. 山东大学学报 (医学版), 2023, 61(5): 31-36.

SONG Han, WANG Zhenhua, WEI Duoliang, XU Kai, LI Bowen, ZHAO Xin. Impacts of preoperative MELD grades on the postoperative early outcomes of 304 acute Standford type A aortic dissection patients[J]. Journal of Shandong University (Health Sciences), 2023, 61(5): 31-36.

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