摘要
目的探讨Stanford A型主动脉夹层(TAAD)术后早期死亡的危险因素。方法计算机检索CNKI、万方、CBM、VIP中文数据库和Pubmed、Cochrane Library、Web of Science、Embase英文数据库收集2010年1月1日—2022年8月12日关于TAAD术后早期死亡危险因素的相关文献,由2位评价者独立筛选文献、提取数据并进行文献质量评价,运用RevMan 5.4和Stata 16统计学软件对收集的资料进行meta分析,采用卡斯尔-渥太华量表(NOS)对纳入文献的质量进行评价。结果本研究最终纳入19项回顾性病例对照研究,共8088例TAAD,其中术后早期死亡1097例,非死亡6991例,NOS评价纳入文献质量均在6分及以上。meta分析结果显示,术前休克或低血压、年龄>60岁、术前肾功能不全、术后肾功能不全、体外循环时间过长、同期行冠状动脉旁路移植术、术前昏迷、手术时间过长和术前D-二聚体水平升高是TAAD患者术后早期死亡的危险因素。结论目前证据表明术前休克或低血压、年龄>60岁、术前肾功能不全、术后肾功能不全和体外循环时间过长等多项因素是TAAD患者术后早期死亡的危险因素,可为临床工作提供参考,以降低TAAD术后早期病死率。
Objective To analyze the risk factors for early death after Stanford type A aortic dissection(TAAD).Methods Databases including CNKI,Wanfang,CBM,VIP,Pubmed,Cochrane Library,Web of Science and Embase were searched to collect relevant literature on risk factors for early death after TAAD from January 1,2010 to August 12,2022.Two evaluators independently screened the literature,extracted the data and evaluated the quality of the literature.RevMan 5.4 and Stata 16 software were used for meta-analysis of the collected data and the Newcastle-Ottawa Scale(NOS)was used to evaluate the quality of the included studies.Results Nineteen retrospective case-control studies with a total of 8088 patients were eventually included,involving 1097 early deaths and 6991 non-deaths.The quality of the included literature was 6 points or above on NOS scale evaluation.Meta-analysis showed that patients with preoperative shock or hypotension,age>60 years,preoperative renal insufficiency,postoperative renal insufficiency,prolonged cardiopulmonary bypass,simultaneous coronary artery bypass grafting,preoperative coma,prolonged duration of operation,and higher preoperative D-dimer were risk factors for early death after TAAD.Conclusion The existing evidence shows that a variety of factors,such as preoperative shock or hypotension,age>60 years,preoperative renal insufficiency,postoperative renal insufficiency,prolonged cardiopulmonary bypass,are the risk factors for early postoperative death of TAAD patients,which can provide reference for clinical practice in order to reduce the early mortality after TAAD.
作者
刘跃
徐宇
李玥锦
邱昌涛
龚昆梅
LIU Yue;XU Yu;LI Yuejin;QIU Changtao;GONG Kunmei(The First Department of General Surgery,the Affiliated Hospital of Kunming University of Science and Technology the First People's Hospital of Yunnan Province,Kunming 650032,China)
出处
《转化医学杂志》
2023年第2期109-116,共8页
Translational Medicine Journal
基金
国家自然科学基金(81960447)
云南省陈忠专家工作站(202005AF150018)。
