中国全科医学2025，Vol.28Issue(21)：2618-2624,2651,8.DOI:10.12114/j.issn.1007-9572.2023.0694
中青年急性Stanford A型主动脉夹层患者杂交手术与孙氏手术短期预后比较研究
Short-term Prognosis of Acute Stanford A Aortic Dissection in Young and Middle-aged Patients Treated with a Hybrid Surgery Versus Sun's Procedure
摘要
Abstract
Background The incidence of acute Stanford A aortic dissection(ASAAD)is becoming younger and younger.Surgical procedures for ASAAD depend on the distinct characteristics of onset.Currently,the Sun's procedure and hybrid surgery are widely used surgical methods for treating ASAAD,but the short-term prognosis in young and middle-aged patients is rarely studied.Objective To compare the short-term prognosis of young and middle-aged ASAAD patients younger than 60 years treated with a hybrid surgery versus Sun's procedure.Methods Clinical data of 266 ASAAD patients younger than 60 years who were surgically treated in Department of Cardiac Surgery,the Fourth Hospital of Hebei Medical University from January 2015 to June 2021 were retrospectively analyzed,including 184 patients undergoing the Sun's procedure(Sun's procedure group),and 82 treated with a hybrid surgery(hybrid surgery group).Propensity score matching(PSM)with a caliper value of 0.03 was adopted,and a total of 78 pairs of matched patients were obtained.Kaplan-Meier survival curve was used to compare the in-hospital mortality between groups.Results After PSM,there were 78 patients in both groups,including 58 males and 20 females.Except for cardiac troponin I(cTnI),there were no statistically significant differences in other indicators between the two groups(P>0.05).After PSM,patients in the hybrid surgery group had significantly more coronary/femoral artery bypass grafting procedures(28.2%vs.11.5%,P=0.009),higher lowest nasal temperature[28.0(27.0,28.8)℃vs.25.5(24.6,28.6)℃,P<0.001]and lowest anal temperature[28.5(27.5,29.5)℃vs.26.3(26.0,28.6)℃,P<0.001],lower highest lactate value[5.2(1.9,9.9)mmol/L vs.9.9(4.3,15.1)mmol/L,P<0.001],and less transfusions of erythrocytes[10.0(6.0,12.0)×109/L vs.13.0(8.0,16.5)×109/L,P=0.004],cold precipitation[(12.8±2.8)µ vs.(16.4±4.3)µ,P<0.001]and plasma[600.0(443.7,800.0)mL vs.800.0(587.5,1 412.5)mL,P=0.011]than those of the Sun's procedure group.After PSM,the incidence of hypoproteinemia was significantly higher in the hybrid surgery group than the Sun's procedure group(33.3%vs.9.0%,P<0.001).The Kaplan-Meier survival curve analysis showed a significantly lower 30-day in-hospital mortality in the hybrid surgery group than the Sun's procedure group(7.7%vs.25.6%,P=0.030).Conclusion A hybrid surgery leads to a lower 30-day in-hospital mortality in young and middle-aged ASAAD patients,but higher risk of complications like stroke,paraplegia and hypoproteinemia than the Sun's procedure.An individualized selection of the optimal surgical regimen is required for preventing risks and strengthening the management of postoperative complications.关键词
急性Stanford A型主动脉夹层/主动脉疾病/杂交手术/孙氏手术/倾向性评分Key words
Acute Stanford A aortic dissection/Aortic diseases/Hybrid surgery/Sun's procedure/Propensity score分类
医药卫生引用本文复制引用
张云静,孙玥,苏鹏,赵永波,马冬..中青年急性Stanford A型主动脉夹层患者杂交手术与孙氏手术短期预后比较研究[J].中国全科医学,2025,28(21):2618-2624,2651,8.基金项目
国家自然科学基金资助项目(81541149) （81541149）
河北省自然科学基金面上项目(H2022206279) （H2022206279）
神经与血管生物学教育部重点实验室主任基金青年基金项目(NV20210006) （NV20210006）
河北省高等学校科学技术研究项目(QN2022164) （QN2022164）
2022年度河北省医学科学研究重点项目(20221293) （20221293）
河北省卫生健康委政府资助临床医学优秀人才培养项目(ZF2025226) （ZF2025226）
