Analysis Of Risk Factors For Acute Lung Injury After Acute Stanford Type A Aortic Dissection

Objectives:To determine risk factors associated with postoperative acute lung injury after surgery for acute type A aortic dissection and find coping methods for reducing the possibility of acute lung injury after surgery for acute type A aortic dissection.Methods:The clinical data of patients with Stanford type A aortic dissection diagnosed in the affiliated hospital of Qingdao University from July 1,2018 to July 1,2019 were analyzed retrospectively.The clinical data of patients with type A aortic dissection undergoing operation include: age,gender(male/female),BMI(≥25/<25),smoking history,hypertension history,coronary heart disease history,diabetes history,pericardial effusion,preoperational oxygenation index,preoperational hemoglobin,preoperational leukocyte,C-reactive protein,preoperational D-Dimer.The intraoperative and postoperative data included:cardiopulmonary bypass time,heart block time,deep hypothermia circulatory arrest time,postoperative hemoglobin,postoperative blood glucose,intraoperative and postoperative red blood cell transfusion,intraoperative and postoperative plasma transfusion,24-hour induced flow.The prognostic factors included: mechanical ventilation time,ICU stay time,postoperative discharge time,liver function abnormality,renal function abnormality,pulmonary infection,mental symptoms,and the number of hospital deaths.The patients were divided into hypoxemia group(Pa O2/Fi O2≤200 mmhg)(n=28)and non hypoxemia group(Pa O2/Fi O2>200 mmhg)(n=60).The clinical data of the two groups were analyzed and compared by t-test,chi square test and other statistical methods.Results:From the patients who were diagnosed as acute type A aortic dissection in the Department of Cardiology of the Affiliated Hospital of Qingdao University from July 1,2018 to July 1,2019,through certain inclusion criteria and exclusion criteria,a total of 88 people were selected,including 59 men and 29 women,with a male to female ratio of 2.03:1,an average age of 55.00±13.42,33 with BMI≥25,42 with a history of smoking,74 with a history of hypertension,8 with a history of coronary heart disease and 10 with a history of diabetes.In this study,the incidence of hypoxemia was 31.8%.There was statistical significance in age,BMI and preoperative oxygenation index(P<0.05).There was no statistical significance in gender,smoking history,hypertension history,coronary heart disease history,diabetes history,pericardial effusion,preoperative hemoglobin,leukocyte,CRP and preoperational D-Dimer(P>0.05).There were statistical significance in the intraoperative and postoperative data,such as intraoperative and postoperative red blood cell infusion,intraoperative and postoperative plasma infusion,cardiopulmonary bypass time,deep hypothermia circulatory arrest time(P<0.05).There was no statistical significance in the time of myocardial block,postoperative hemoglobin,postoperative blood glucose and 24 h induced flow(P>0.05).There was no significant difference in the time of mechanical ventilation,ICU stay,discharge and pulmonary infection(P<0.05).Conclusions:(1)The incidence of hypoxemia was high in patients with acute Stanford A aortic di ssection during perioperative period,which was 31.8% in this study.(2)The results showed that BMI,the time of deep hypothermia circulatory arrest,int raoperative and postoperative transfusion of red blood cells and intraoperative and pos toperative transfusion of plasma were the independent risk factors of postoperative hy poxemia in patients with aortic dissection.(3)Postoperative acute lung injury in patients with acute Stanford type A aortic disse ction was associated with postoperative mechanical ventilation duration,ICU retention time,postoperative discharge time,and postoperative pulmonary infection.