摘要
目的探讨急性A型主动脉夹层患者术前C反应蛋白（CRP）与白蛋白（ALB）比值（CRP／ALB）在手术后预后预测中的价值，进一步分析其住院期间的死亡危险因素。方法回顾性分析广东省人民医院2015午2月至2015年11月连续收治的104例StanfordA型主动脉夹层手术患者的病例资料。夺观察排除标准：术前未检测CRP、白蛋白，术前感染，肝硬化、低蛋白血症。共83例患者符合入选条什。根据住院期间是否死亡，分为存活组和死亡组；对CRP／ALB、术前及手术相关因素进行住院期间死亡的单因素和多因素Logistic回归分析。结果存活组与死亡组患者术前血清CRP、ALB浓度比较差异无统计学意义（均P〉0．05），死亡组CRP／ALB[（5．63±4．47）W．（3．16±2．58），P=0．010]、APACHEⅡ评分[（26．45±4．08）min us．（20．10±3．74）min，P〈0．01]和体外循环时间[（302．64±89．26）minUS．（234．23±53．80）分，P=0．031]显著高于存活组，起病24h内急诊手术者死亡率（63．64％VS．5．56％，P〈0．01）明显高于延期手术患者。多因素Logistic回归分析显示：术前CRP／ALB增大[比值比（OR）=1．322，95％可信区间（c，）1．035～1．689，P=0．0251、24h内急诊手术（OR=31．595，95％CI5．655—176．52，P〈0．01）是手术患者住院期间死亡的独寺危险因素。结论急性A型主动脉夹层术前CRP与白蛋白比值增大、24h内急诊手术与仲院死亡相关，是手术患者住院期间死亡的独立危险因素。
Objective To investigate the clinical value of the ratio of C-reactive protein to albumin for predicting hospital mortality, and to look for predictors of in-hospital death in patients with repaired acute type A aortic dissection. Methods Clinical data of the 104 patients treated A type acute aortic dissection surgery from February 2015 to November 2015 were collected in Guangdong General Hospital. Patients without preoperative detection of CRP and albumin, patients with preoperative infection, liver cirrhosis and hypoproteinemia were excluded. Total of 83 enrolled patients were divided into the survival group and the non-survival group according to in-hospital death. CRP/ALB, general clinical data, related factors of operation and postoperative were evaluated by means of univariate and multivariate logistic regression analysis to identify relative risk factors of in-hospital death in patients with repaired acute type A aortic dissection. Results There was no significant difference in serum CRP, ALB levels on day 0 between the survival and the non-survival before the operation （ P all 〉 0. 05 ） . The preoperative CRP/ALB [ （ 5.63 ± 4.47 ） vs. （3.16±2.58）, P=0.010）], APACHE lIscores [ （26.45±4.08）vs. （20.10±3.74）, P〈0.01] and cardiopulmonal~ bypass times [ （302. 64 ±89.26） rain vs. （234. 23 ±53.80） rain, P =0. 031 ] of the non-survival was significantly higher than that of the survival, The mortality （5.56%vs. 63.64% , P 〈 0. 01 ） of the patients, who were operationed within 24 hours ＇after onset, was significantly higher than that of patients with delayed operation. Logistic regression analysis showed that the higher preoperative CRP/ALB [Odds Ratio （OR） = 1. 322, 95% confidence interval （C1） 1. 035-1. 689, P = 0.025 ], patients operationed within 24 hours of onset （ OR = 31. 595, 95% CI 5. 655-176. 52, P 〈 0. 01 ） as the independent risk factors of in-hospital death in patients with repaired acute type A aortic dissection. Conclusions The higher CRP/ALB ratio and patients operated within 24 hours after onset were difinitely independent factors for less in-hospital death in patients with repaired acute type A aortic dissection.
出处
《中华急诊医学杂志》
CAS
CSCD
北大核心
2016年第6期764-768,共5页
Chinese Journal of Emergency Medicine
基金
国家临床重点专科建设项目（2012-649）
广州市临床医学研究与转化中心试点建设项日（201508020005）
广东省医学科研基金项目（B2014003）
关键词
主动脉夹层
C反应蛋白
白蛋白
APACHEⅡ评分
体外循环
急诊手术回归分
析
颅后
Aortic dissection
C-reactive protein （CRP）
Albunfin （ ALB ）
APACHE II score
Cardiopuhnonary bypass
Emergency operation
Regression analysis
Prognosis
