Risk Factors Of Delayed Extubation After Acute Stanford Type A Aortic Dissection

Background and Purpose:Acute Stanford type A aortic dissection is an extremely dangerous aortic disease with rapid progression and high mortality rate.Surgical treatment is the main treatment method.With the increasing number of treatment cases,it is difficult for a considerable number of patients to remove tracheal intubation in a short term,while long-term mechanical ventilation will not only increase the probability of pulmonary complications.Moreover,it will further increase the burden of other tissues,and eventually lead to serious impairment of other organ functions,resulting in the adverse consequences of reduced long-term survival rate after surgery.At the same time,prolonged postoperative catheter time will also prolong the stay time in intensive care unit and increase the economic burden of patients.This study aims to find independent risk factors for delayed tracheal intubation extraction in patients with Stanford type A AD,and guide physicians to take corresponding preventive measures before surgery to shorten the postoperative catheter time of patients,reduce hospitalization costs and improve the quality of life of patients.Method:According to the inclusion and exclusion criteria,A total of 154 patients diagnosed with Stanford type A or Debakey type I aortic dissection and receiving open surgical treatment by aortic angiography in our hospital from September 2019 to June 2022 were collected,including 123 males(79.9%).31 cases(20.1%)were female.They were divided into the normal extubation group and the delayed extubation group according to whether there was a delay in extubation after surgery.General data,preoperative,intraoperative and postoperative clinical data were retrospectively compared among the groups.Univariate statistical analysis was carried out on the factors that might cause delayed extubation after TAAD surgery.Identify independent risk factors that may influence delayed extubation after TAAD surgery.Results:Among the 154 patients,there were 70 cases in the delayed extubation group and84 cases in the normal extubation group,with a delayed extubation rate of 45.5%.Comparing relevant data between the two groups,univariate analysis showed statistically significant results as follows: Gender,BMI,preoperative platelet count,preoperative D-dimer,waiting time from onset to operation < 72 h,Operation duration,extracorporeal circulation duration,ascending aorta occlusion duration,intraoperative red suspension amount,intraoperative blood loss,postoperative platelet count,postoperative hemoglobin,postoperative AST > 200U/L,postoperative ALT >200U/L,postoperative bilirubin > 50μmol/L,postoperative acute renal insufficiency(serum creatinine> 186)μmol/L),postoperative platelet infusion,postoperative plasma infusion,postoperative plasma infusion.Multivariate logistic regression analysis of the above factors showed that the duration of extracorporeal circulation(p=0.018),the waiting time from onset to operation < 72h(p=0.045),postoperative acute renal insufficiency(serum creatinine> 186)μmol/L)(p=0.005)and large plasma infusion(p=0.001)were independent risk factors for delayed extubation after TAAD.In addition,the length of hospital stay and hospitalization cost in the delayed extubation group were significantly higher than those in the normal extubation group.Conclusions:The wait time from onset to surgery < 72 h,longer extracorporeal circulation,postoperative acute renal insufficiency(serum creatinine> 186 μmol/L),and postoperative large plasma infusion are independent risk factors for delayed extubation after TAAD.