| Objective: The prognosis of patients with Stanford type A aortic dissection is very dangerous.If surgery is not performed in time,the expected 90-day mortality rate can range up to 90%.There are two leading causes of death in patients with aortic dissection which are the rupture of the dissection and the appearance of serious complications.In addition to cardiovascular disease,Stanford A aortic dissection is often accompanied by dysfunctions of the nervous system,respiratory system,digestive system,urinary system,motor system and other systems.The system dysfunctions may be caused by the dissection involving the main blood supply arteries of the organs.Organ ischemia can also be caused by systemic inflammation due to dissection.Preoperative organ dysfunction not only greatly increases the mortality of patients before surgery,but also causes many difficulties and risks to such patients in anesthesia.In the past,the effects of system dysfunction other than cardiovascular system on the prognosis of aortic dissection were often studied for a certain organ.Aortic dissection often involved multiple organs at the same time.A patient may have acute lung injury,renal insufficiency and several system complications such as intestinal necrosis and also manifested as symptoms of multiple organ failure such as hypoxemia,anuria,acidosis,and septic shock.Today,anesthesiology is transforming into perioperative medicine,and is not limited to the concept of anesthesia and analgesia.Comprehensive evaluation of multiple organ involvement before Stanford A aortic dissection,especially comparing the different effects of extra-cardiac multi-organ dysfunction and involvement of single extra-cardiac organ on the prognosis,have significance to formulate a reasonable anesthesia plan and improve the prognosis of aortic dissection,and improve the survival rate of perioperative period.Methods:We select 112 patients with acute Stanford A aortic dissection from January2017 to August 2020 who were operated in the first Affiliated Hospital of Dalian Medical University as retrospective analysis.A retrospective analysis of 112 patients with acute aortic dissection type A in the First Affiliated Hospital of Dalian Medical University from January 2017 to August 2020 was selected.Collect the basic data of the three groups of patients before the operation,the condition of the involved organs,the test results,the relevant indicators during the operation,the postoperative experimental results,the amount of input and output,the occurrence of complications and the recovery events.Compare them with statistical methods to determine whether the results are differences.Then,group C was divided into two subgroups,group D and group M,according to the number of patients with 2 or 3 or more extra-cardiac organs.Statistical analysis and comparison of the postoperative indexes of these two groups were carried out.Results: A total of 112 patients with acute type A dissection who underwent emergency surgery were collected.Among them,there were 34 patients in group A(the number of organs involved is 0),50 patients in group B(the number of organs involved was 1),and 28 patients in group C(the number of organs involved was greater than Equal to 2),respectively accounting for 30.4%,44.6%,and 25.0%.1.In the manifestation of organ damage before surgery,group B has the highest incidence of hypoxemia,followed by limb ischemia;in group C,hypoxemia has the highest incidence,followed by limb ischemia.The incidence of gastrointestinal disorders is the lowest.The incidence of limb ischemia,liver and kidney damage,nervous system damage,and gastrointestinal dysfunction before surgery were significantly higher in group C than in group B.Compared with preoperative creatinine and urea nitrogen,the value in group C was remarkably higher than those in group A and B.While the values of total protein in group C were significantly lower than those in group A and B.2.For the operation time,group C was the longest.The amount of cryoprecipitate transfusion in group C was more than that in group A and the urine volume during perfusion in group C was conspicuously less than that in group A.Comparing the amount of plasma transfusion during operation,group C and group B was statistically higher than that of group A.3.Compared group A with group C in postoperative extubation time,postoperative ICU stay time,and the amount of plasma transfusion,patients in group A got a greater chance to experience the occurrance of the above.These 3 groups had significant differences in wake-up time,which patients of group C need the most time to recover from anaesthesia.The level of creatinine and urea in group B and C were conspicuously higher,and group C got the maximum value.For the white blood cell,group C was statistically higher than that of group A.In the incidence of postoperative renal insufficiency and postoperative fever,group C was remarkably higher than group A.Compared with group A and group B,group C got the most patients to experience stroke and postoperative rescue events.The incidence of thoracentesis in group B was statistically lower than that in group A and C.Of these 112 patients,13 died totally.The patients in group C died the most after surgery,and there was a meaningful difference between group C and group A.4.In group C,patients with 2 organs involved and 3 or more were divided into subgroups D and M.There were 18 persons in group D and 10 persons in group M.The proportions of patients in group C were 64.3% and 35.7%.The value of urea and the postoperative ICU stay time in group M were significantly higher than group D.The two groups had significant differences in digestive system complications,continuous renal replacement therapy,secondary operations within 48 hours,and postoperative fever,which group M was more likely to occur above incidences than that of group D.The two groups had no significant differences in survival.Conclusions : 1.About 70% of patients with aortic dissection involve extra-cardiac organs.Whether a single organ or multiple organs are involved,hypoxemia is the most common complication.2.Limb ischemia is most likely to occur when dissection leads to tissue malperfusion,and the incidence of renal,liver,and gastrointestinal dysfunction is low.Once it occurs,it indicates that the dissection involves a wide range.3.Patients with dissection involving two or more extra-cardiac organs before surgery have more severe inflammation.4.The incidence of postoperative hypoxemia in aortic dissection patients is higher,and patients in group C are more likely to have postoperative adverse events.5.There is no significant difference in prognosis between no extra-cardiac organ involvement group and involvement of an extra-cardiac organ group.6.Patients with two or more extra-cardiac organs have a long recovery time,high mortality rate,and poor prognosis,but there is no significant difference in prognosis between two extracardiac organs group and more than two extra-cardiac organs group. |
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