Risk factors for gastrointestinal bleeding after type A aortic dissection surgery:A retrospective cohort study
Objective To investigate the risk factors for postoperative gastrointestinal bleeding(GIB)in patients with type A aortic dissection,and further discuss its prevention and treatment.Methods The clinical data of patients with type A aortic dissection admitted to the Department of Cardiovascular Surgery of the First Affiliated Hospital of Naval Medical University from 2017 to 2021 were retrospectively analyzed.Patients were divided into a GIB group and a non-GIB group based on the presence of GIB after surgery.The variables with statistical differences between two groups in univariate analysis were included into a multivariate logistic regression model to analyze the risk factors for postoperative GIB in patients with type A aortic dissection.Results There were 18 patients in the GIB group including 12 males and 6 females,aged 60.11±10.63 years,while 511 patients in the non-GIB group including 384 males and 127 females,aged 49.81±12.88 years.In the univariate analysis,there were statistical differences in age,preoperative percutaneous arterial oxygen saturation(SpO2)＜95％,intraoperative circulatory arrest time,postoperative low cardiac output syndrome,ventilator withdrawal time＞72 hours,postoperative FiO2≥50％,continuous renal replacement therapy(CRRT)rate,extracorporeal membrane oxygenation(ECMO)rate,infection rate,length of hospital stay and ICU stay,and in-hospital mortality(all P＜0.05).In the multivariate logistic regression analysis,preoperative SpO2＜95％(OR=10.845,95％CI2.038-57.703),ventilator withdrawal time＞72 hours(OR=0.004,95％CI 0.001-0.016),CRRT(OR-6.822,95％CI 1.778-26.171)were risk factors for postoperative GIB in patients(P≤0.005).In the intra-group analysis of GIB,non-occlusive mesenteric ischemia(NOMI)accounted for 38.9％(7/18)and was the main disease type for postoperative GIB in patients with type A aortic dissection.Conclusion In addition to patients with entrapment involving the superior mesenteric artery who are prone to postoperative GIB,preoperative SpO2＜95％,ventilator withdrawal time＞72 hours,and CRRT are independent risk factors for postoperative GIB in patients with type A aortic dissection.NOMI is a major disease category for GIB,and timely diagnosis and aggressive treatment are effective ways to reduce mortality.Awareness of its risk factors and treatment are also ways to reduce its incidence.
Type A aortic dissectiongastrointestinal bleedingnon-occlusive mesenteric ischemia
NETL
NSTL
万方数据
