CT血管造影情報に基づく急性スタンフォードA大動脈解離患者における術後感染症と脳神経合併症の危険因子の解析

Analysis of Risk Factors for Postoperative Infection and Neurological Complications in Patients with Acute Stanford A AD According to CT angiography Information.

• Sheng Zang
• Yu Zhang
• Jiarui Xu
• Yaming Du

抄録

本研究の目的は，急性Stanford A大動脈解離患者における術後感染症と脳神経合併症の危険因子をCT血管造影情報に基づいて検討することであった。本研究では，CT（コンピュータ断層撮影）血管造影によりスタンフォードA大動脈解離と診断され，2017年3月から2019年12月までに当院でSunの手術を受けた患者122名を対象とした。本症例の手術後の感染症と神経学的合併症に基づき、術後合併症なし（A群）、術後感染症あり（B群）、術後神経学的合併症あり（C群）、術後感染症と神経学的合併症あり（D群）の4群に分けた。既往歴、クレアチニン値、手術時間、術中輸血、集中治療室（ICU）滞在時間、ドレナージチューブ留置時間、気管切開の有無を記録し、分析した。手術後の感染症や神経合併症に関連する因子については単因子分析を行い、統計的に差がある場合はさらに重ロジスティック回帰分析を行った。その結果、A群の血中クレアチニン値と年齢はB、C、D群に比べて有意に低く（P＜0.05）、C、D群の総手術時間、体外循環時間、ブロッキング時間は他の群に比べて有意に高く（P＜0.05）、A群の術後血漿輸血量、血小板量、ICU滞留時間は他の3群に比べて有意に差があった（P＜0.05）。ICUに複数回転院した患者の割合、排液チューブ滞留時間は4群で差がなかった（P>0.05）。B群とD群の経鼻栄養チューブ保持時間、補助換気時間、複数回挿管、気管切開、継続的腎代替療法を行った患者の割合は、他の2群と有意差があった（P＜0.05）。年齢、血中クレアチニン、全手術期間、ICU滞在期間は、単因子ロジスティック分析に基づいて、スタンフォードA型AD後の感染症および神経学的合併症と有意に相関していた（P<0.05）。多変量ロジスティック回帰分析では、血漿輸血量、補助換気時間、体外循環時間、ICU滞在時間が術後感染症および神経学的合併症と有意に関連していることが示された（P<0.05）。その結果、血漿輸血量、補助換気時間、体外循環時間、ICU滞在時間は、スタンフォードA型AD後の感染症および神経学的合併症の独立した危険因子であることが示された。術後の感染症や神経学的合併症の発生は、手術中に関連するパラメータをコントロールすることで減少させることが可能である。

The objective of this study was to explore the risk factors of postoperative infection and cerebral neurological complications in patients with acute Stanford A aortic dissection based on the CT angiography information. 122 patients who were diagnosed as Stanford A ADs by computed tomography (CT) angiography and were treated with Sun's surgery from March 2017 to December 2019 in our hospital were selected in this study. Based on infections and neurological complications after surgery of the patients, they were divided into four groups: no postoperative complications (group A), postoperative infections (group B), postoperative neurological complications (group C), postoperative infection and neurological complications (group D). Previous medical history, creatinine value, surgery duration, intraoperative blood transfusion, intensive care unit (ICU) residence duration, drainage tube retention duration, and tracheotomy of the patients were recorded and analyzed. The single factor analysis was taken for factors related to infection and neurological complications after surgery, and the multiple logistic regression analysis was further taken if there was any statistical difference. The results showed that the blood creatinine value and age of patients in group A were significantly lower than those in group B, C, and D (P <  0.05); the total surgery duration, extracorporeal circulation duration, and blocking duration in patients in group C and D were significantly higher than those in other groups (P <  0.05); postoperative plasma transfusion volume, platelet volume, and ICU residence duration in group A were significantly different from the other three groups (P <  0.05). There was no difference in the percentage of patients transferred to the ICU for multiple times, and drainage tube retention duration of patients in four groups (P >  0.05). The nasal feeding tube retention duration, the auxiliary ventilation duration, and the percentages of patients with multiple intubations, tracheotomies, and continuous renal replacement therapy in group B and D were significantly different from those in the other two groups (P <  0.05). Age, blood creatinine, total surgery duration, and ICU residence duration were significantly correlated with infection and neurological complications after Stanford A AD based on the single factor logistic analysis (P <  0.05). The multivariate logistic regression analysis showed that the plasma transfusion volume, auxiliary ventilation duration, extracorporeal circulation duration, and ICU residence duration were significantly related to postoperative infection and neurological complications (P <  0.05). It indicated that the plasma transfusion volume, auxiliary ventilation duration, extracorporeal circulation duration, and the ICU residence duration are independent risk factors of the infection and neurological complications after Stanford A AD. The occurrence of postoperative infection and neurological complications can be reduced by control related parameters during the surgery.

Copyright © 2020. Published by Elsevier B.V.