Risk Factors for Hypoxemia after Surgery for Acute Aortic Dissection_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

SHENG Wei , CHI Yifan , HOU Wenming , SUN Long , NIU Zhaozhuo , SUN Yong , Lin Mingshan , LU Xiao.

Department of Cardiac Surgery，Qingdao　Municipal Hospital，Qingdao 266071，Shandong，P. R. China;

Corresponding author：

Keywords：

Acute aortic dissection; 　Hypoxemia; 　Risk factor

DOI：

10.7507/1007-4848.20130091

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Objective To determine risk factors associated with postoperative hypoxemia after surgery for acute aortic dissection. Methods We retrospectively analyzed clinical data of 116 patients with acute aortic dissection who underwent endovascular stent-graft exclusion or open surgery in Qingdao Municipal Hospital from February 2007 to February　2012. All the 116 patients were diagnosed as acute aortic dissection by CT angiography （CTA），including 60 patients with Stanford type A aortic dissection and 56 patients with Stanford type B aortic dissection. According to whether they had postoperative hypoxemia，all the 116 patients with acute aortic dissection were divided into hypoxemia group［arterial　partial pressure of oxygen （PaO2） /fraction of inspired oxygen （FiO2）＜200 mm Hg］：33 patients including 28 males and 5 females with their age of 52.7±11.4 years； and non-hypoxemia group（PaO2/FiO2≥200 mm Hg）：83 patients including　66 males and 17 females with their age of 55.0±13.8 years. Perioperative clinical data were analyzed and compared　between the two groups. Multivariate logistic regression was performed to identify risk factors of postoperative hypoxemia after surgery for acute aortic dissection. Results The incidence of postoperative hypoxemia after surgery for acute aortic dissection was 28.4% （33/116）. Perioperative death occurred in 13 patients（11.2%，including 8 patients in the hypoxemia group and 5 patients in the non-hypoxemia group）. Univariate analysis showed that preoperatively the percentages of　patients with body mass index（BMI）＞ 25 kg/m2，smoking history，duration from onset to operation ＜24 h，preoperative　PaO2/FiO2≤300 mm Hg，and patients undergoing open surgery in the hypoxemia group were significantly higher than those　in the non-hypoxemia group（P＜0.05）. Deep hypothermic circulatory arrest（DHCA） ratio，blood transfusion in 24 hours　postoperatively，mechanical ventilation time，length of ICU stay and hospital stay in the hypoxemia group were significantly　higher or longer than those in the non-hypoxemia group（P＜0.05）. Logistic multivariate regression identified BMI＞25 kg/m2（RR=98.861，P=0.006），DHCA（RR=22.487，P=0.007），preoperative PaO2/FiO2≤300 mm Hg（RR=9.080，P=0.037） and blood transfusion＞6 U in 24 hours postoperatively（RR=32.813，P=0.003） as independent　predictors of postoperative hypoxemia for open-surgery patients，while BMI＞25 kg/m2 （RR=24.984，P=0.036） and preoperative PaO2/FiO2 ratio≤300 mm Hg （RR=21.145，P=0.042） as independent predictors of hypoxemia for endovascular stent-graft exclusion patients. Conclusion Postoperative hypoxemia is a common complication after surgery for acute aortic dissection. Early interventions for obesity and preoperative hypoxemia，and reducing perioperative blood transfusion may decrease the incidence of postoperative hypoxemia after surgery for acute aortic dissection.

Citation： SHENG Wei,CHI Yifan,HOU Wenming,SUN Long,NIU Zhaozhuo,SUN Yong,Lin Mingshan,LU Xiao.. Risk Factors for Hypoxemia after Surgery for Acute Aortic Dissection. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2013, 20(3): 298-303. doi: 10.7507/1007-4848.20130091 Copy

1.	Hata MM， Suzuki MM， Sezai AA， et al. Outcome of less invasive proximal arch replacement with moderate hypothermic circulatory arrest followed by aggressive rapid re-warming in emergency surgery for type A acute aortic dissection. Circ J， 2009， 73 （1）：69-72.
2.	Trimarchi SS， Nienaber CC， Rampoldi VV， et al. Contemporary results of surgery in acute type A aortic dissection：the international registry of acute aortic dissection experience. J Thorac Cardiovasc Surg， 2005， 129 （1）：112-122.
3.	Easo JJ， Weigang EE， Hölzl PP， et al. Influence of operative strategy　for the aortic arch in DeBakey type I aortic dissection：analysis of the German registry for acute aortic dissection type A. J Thorac Cardiovasc　Surg， 2012， 144 （3）：617-623.
4.	谢波，薛松，徐根兴，等. 序贯无创通气在冠状动脉旁路移植术后机械通气撤机中的应用. 中国胸心血管外科临床杂志， 2010， 17 （3）：206-210.
5.	Ji QQ， Mei YQ， Wang XS， et al. Study on the risk factors of postoperative hypoxemia in patients undergoing coronary artery bypass grafting.Circ J， 2008， 72 （12）：1975-1980.
6.	陈德海，王萍，张申，等. 非体外循环冠状动脉旁路移植术后呼吸功能衰竭的治疗. 中国胸心血管外科临床杂志， 2012， 19 （1）：90-92.
7.	中华医学会呼吸病学分会. 急性肺损伤/急性呼吸窘迫综合征的诊断标准（草案）. 现代实用医学， 2002， 14 （3）：161.
8.	Nakajima TT， Kawazoe KK， Izumoto HH， et al. Risk factors for hypoxemia after surgery for acute type A aortic dissection. Surg　Today， 2006， 36 （8）：680-685.
9.	钱永兵，王瑞兰. 肥胖与急性肺损伤研究进展. 国际呼吸杂志， 2011， 31 （2）：147-150.
10.	Mccallister JJ， Adkins EE， O'brien JJ. Obesity and acute lung　injury. Clin Chest Med， 2009， 30 （3）：495-508.
11.	Tilg H， Moschen AR.Role of adiponectin and PBEF/visfatin as regulators of inflammation：involvement in obesity-associated diseases. Clin Sci （Lond）， 2008， 114 （4）：275-288.
12.	Codoñer-Franch PP， Valls-Bellés VV， Arilla-Codoñer AA， et al. Oxidant mechanisms in childhood obesity：the Link between inflammation and oxidative stress. Transl Res， 2011， 158 （6）：369-384.
13.	Sangani RG， Ghio AJ.Lung injury after cigarette smoking is particle related. Int J Chron Obstruct Pulmon Dis， 2011， 6：191-198.
14.	郭武，张孝彬，廖秀清，等. 吸烟对中年男性肺功能的影响. 四川医学， 2006， 27 （8）：806-807.
15.	Apostolakis EE， Koletsis EN， Baikoussis NG， et al. Strategies to prevent intraoperative lung injury during cardiopulmonary bypass. J Cardiothorac Surg， 2010， 5：1.
16.	Chao YK， Wu YC， Yang KJ， et al. Pulmonary perfusion with　L-arginine ameliorates post-cardiopulmonary bypass lung injury in a rabbit model. J Surg Res， 2011， 167 （2）：e77-e83.
17.	高波涛，郑景浩，徐志伟，等. 早期巨噬细胞激活和核因子-κB活性在深低温停循环肺损伤中的作用. 中国体外循环杂志， 2009， 7 （2）：109-112.
18.	Tavares-Murta BM， Cordeiro AO， Murta EF， et al. Effect of myoca-rdial protection and perfusion temperature on production of cytokines and nitric oxide during cardiopulmonary bypass. Acta Cir Bras， 2007， 22 （4）：243-250.
19.	Kagawa HH， Morita KK， Nagahori RR， et al. Prevention of　ischemia/reperfusion-induced pulmonary dysfunction after cardiopulmonary bypass with terminal leukocyte-depleted lung reperfusion. J Thorac Cardiovasc Surg， 2010， 139 （1）：174-180.
20.	许卫江，陈祖君，肖红艳，等. 体外循环冠状动脉旁路移植术后低氧血症的危险因素分析. 中国综合临床， 2011， 27 （3）：249-252.
21.	Bernard AA， Davenport DD， Chang PP， et al. Intraoperative transfusion of 1 U to 2 U packed red blood cells is associated with increased 30-day mortality， surgical-site infection， pneumonia， and sepsis in general surgery patients. J Am Coll Surg， 2009， 208 （5）：931-937.
22.	Moskowitz DD， Mccullough JJ， Shander AA， et al. The impact of blood conservation on outcomes in cardiac surgery：is it safe and　effective ? Ann Thorac Surg， 2010， 90 （2）：451-458.
23.	孟毅，董逸飞，董书强，等. 心脏瓣膜手术后呼吸衰竭相关危险因素分析. 中国胸心血管外科临床杂志， 2012， 19 （2）：168-171.
24.	Jo Y， Anzai T， Sugano Y， et al. Early use of beta-blockers attenuates systemic inflammatory response and lung oxygenation impairment after distal type acute aortic dissection. Heart Vessels， 2008， 23 （5）：334-340.
25.	Kurabayashi MM， Okishige KK， Azegami KK， et al. Reduction of the PaO2/FiO2 ratio in acute aortic dissection-relationship between the　extent of dissection and inflammation. Circ J， 2010， 74 （10）：2066-2073.

1. 　Hata MM， Suzuki MM， Sezai AA， et al. Outcome of less invasive proximal arch replacement with moderate hypothermic circulatory arrest followed by aggressive rapid re-warming in emergency surgery for type A acute aortic dissection. Circ J， 2009， 73 （1）：69-72.
2. 　Trimarchi SS， Nienaber CC， Rampoldi VV， et al. Contemporary results of surgery in acute type A aortic dissection：the international registry of acute aortic dissection experience. J Thorac Cardiovasc Surg， 2005， 129 （1）：112-122.
3. 　Easo JJ， Weigang EE， Hölzl PP， et al. Influence of operative strategy　for the aortic arch in DeBakey type I aortic dissection：analysis of the German registry for acute aortic dissection type A. J Thorac Cardiovasc　Surg， 2012， 144 （3）：617-623.
4. 　谢波，薛松，徐根兴，等. 序贯无创通气在冠状动脉旁路移植术后机械通气撤机中的应用. 中国胸心血管外科临床杂志， 2010， 17 （3）：206-210.
5. 　Ji QQ， Mei YQ， Wang XS， et al. Study on the risk factors of postoperative hypoxemia in patients undergoing coronary artery bypass grafting.Circ J， 2008， 72 （12）：1975-1980.
6. 　陈德海，王萍，张申，等. 非体外循环冠状动脉旁路移植术后呼吸功能衰竭的治疗. 中国胸心血管外科临床杂志， 2012， 19 （1）：90-92.
7. 　中华医学会呼吸病学分会. 急性肺损伤/急性呼吸窘迫综合征的诊断标准（草案）. 现代实用医学， 2002， 14 （3）：161.
8. 　Nakajima TT， Kawazoe KK， Izumoto HH， et al. Risk factors for hypoxemia after surgery for acute type A aortic dissection. Surg　Today， 2006， 36 （8）：680-685.
9. 　钱永兵，王瑞兰. 肥胖与急性肺损伤研究进展. 国际呼吸杂志， 2011， 31 （2）：147-150.
10. 　Mccallister JJ， Adkins EE， O'brien JJ. Obesity and acute lung　injury. Clin Chest Med， 2009， 30 （3）：495-508.
11. 　Tilg H， Moschen AR.Role of adiponectin and PBEF/visfatin as regulators of inflammation：involvement in obesity-associated diseases. Clin Sci （Lond）， 2008， 114 （4）：275-288.
12. 　Codoñer-Franch PP， Valls-Bellés VV， Arilla-Codoñer AA， et al. Oxidant mechanisms in childhood obesity：the Link between inflammation and oxidative stress. Transl Res， 2011， 158 （6）：369-384.
13. 　Sangani RG， Ghio AJ.Lung injury after cigarette smoking is particle related. Int J Chron Obstruct Pulmon Dis， 2011， 6：191-198.
14. 　郭武，张孝彬，廖秀清，等. 吸烟对中年男性肺功能的影响. 四川医学， 2006， 27 （8）：806-807.
15. 　Apostolakis EE， Koletsis EN， Baikoussis NG， et al. Strategies to prevent intraoperative lung injury during cardiopulmonary bypass. J Cardiothorac Surg， 2010， 5：1.
16. 　Chao YK， Wu YC， Yang KJ， et al. Pulmonary perfusion with　L-arginine ameliorates post-cardiopulmonary bypass lung injury in a rabbit model. J Surg Res， 2011， 167 （2）：e77-e83.
17. 　高波涛，郑景浩，徐志伟，等. 早期巨噬细胞激活和核因子-κB活性在深低温停循环肺损伤中的作用. 中国体外循环杂志， 2009， 7 （2）：109-112.
18. 　Tavares-Murta BM， Cordeiro AO， Murta EF， et al. Effect of myoca-rdial protection and perfusion temperature on production of cytokines and nitric oxide during cardiopulmonary bypass. Acta Cir Bras， 2007， 22 （4）：243-250.
19. 　Kagawa HH， Morita KK， Nagahori RR， et al. Prevention of　ischemia/reperfusion-induced pulmonary dysfunction after cardiopulmonary bypass with terminal leukocyte-depleted lung reperfusion. J Thorac Cardiovasc Surg， 2010， 139 （1）：174-180.
20. 　许卫江，陈祖君，肖红艳，等. 体外循环冠状动脉旁路移植术后低氧血症的危险因素分析. 中国综合临床， 2011， 27 （3）：249-252.
21. 　Bernard AA， Davenport DD， Chang PP， et al. Intraoperative transfusion of 1 U to 2 U packed red blood cells is associated with increased 30-day mortality， surgical-site infection， pneumonia， and sepsis in general surgery patients. J Am Coll Surg， 2009， 208 （5）：931-937.
22. 　Moskowitz DD， Mccullough JJ， Shander AA， et al. The impact of blood conservation on outcomes in cardiac surgery：is it safe and　effective ? Ann Thorac Surg， 2010， 90 （2）：451-458.
23. 　孟毅，董逸飞，董书强，等. 心脏瓣膜手术后呼吸衰竭相关危险因素分析. 中国胸心血管外科临床杂志， 2012， 19 （2）：168-171.
24. 　Jo Y， Anzai T， Sugano Y， et al. Early use of beta-blockers attenuates systemic inflammatory response and lung oxygenation impairment after distal type acute aortic dissection. Heart Vessels， 2008， 23 （5）：334-340.
25. 　Kurabayashi MM， Okishige KK， Azegami KK， et al. Reduction of the PaO2/FiO2 ratio in acute aortic dissection-relationship between the　extent of dissection and inflammation. Circ J， 2010， 74 （10）：2066-2073.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Risk Factors for Hypoxemia after Surgery for Acute Aortic Dissection

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