| Part ?: Clinical features and risk factors for in-hospital mortality of acute aortic dissectionObjective: This study analyzed the clinical data of acute Stanford A type AD and Stanford B type AD,compared and discussed the incidence,relevant examination,treatment plan and prognosis,studied the predictive factors of differential diagnosis,and analyzed the relevant risk factors of hospital death of acute Stanford A type AD,so as to provide more reasonable reference basis for clinical decision-making.Methods: Retrospective analysis was performed on AAD patients hospitalized in our center from September 2017 to October 2018.Case data were collected and sorted,including basic data,onset time,clinical manifestations,previous medical history,admission signs,imaging and laboratory examinations,surgery and medication,and in-hospital mortality.The clinical characteristics of acute Stanford type A and Stanford type B AD were compared,the acute Stanford type A AD was divided into the nosocomial death group and the nosocomial survival group,and the relevant risk factors and independent risk factors of nosocomial death were analyzed.Establish Excel form,input data,import into SPSS system,and use SPSS 25.0 software for analysis.Results: 1.A total of 391 cases of AAD were included,including 213 cases of acute Stanford type AAD(group A)(54.5%)and 178 cases of acute Stanford type B AD(group B)(45.5%).The hospital mortality of group A(20.7%)was significantly higher than that of group B(4.5%),especially the mortality of conservative treatment(60.8% vs 8.8%).Univariate analysis showed that there were statistically significant differences between the two groups in age,gender ratio,smoking,length of stay,chest tightness,chest pain,abdominal and lower back pain,heart rate and blood pressure,aortic valve murmur,pericardial and pleural effusion,and renal cyst(P<0.05).The mean volume of white blood cells,monocytes,platelets,hemoglobin and platelets; otal bilirubin,total carbon dioxide,high-density lipoprotein,CK-MB and hypersensitive troponin I;D-dimer,FDP,PT,TT,FIB levels were significantly different in the two groups(P<0.05).There was no significant difference in blood type between the two groups.In transthoracic echocardiography(TTE),the left ventricular diameter and the widest diameter of ascending aorta(AAO)in group A were higher than those in group B,while the right ventricular diameter was lower than that in group B(P<0.05).Multivariate binary Logistic regression analysis showed that gender was female,age <67 years old,admission systolic blood pressure <118mm Hg,the widest diameter of AAO >40.5mm,MPV>9.82 fl,d-dimer >7.13mg/L were the predictors for the diagnosis of acute Stanford type A AD.When the diameter of the widest part of AAO =40.5mm,the AUC,sensitivity and specificity of predicating acute Stanford type A AD were 0.80,70.0% and 79.8% respectively.Also,the sensitivity and specificity of d-dimer at 7.13mg/L were 63.5% and 73.3%,respectively.2.There were 213 cases of acute Stanford type A AD,among which 44 cases(20.7%)died in hospital,39 cases(18.3%)were required to be discharged,and 130 cases(61.0%)were discharged after cured and improved.Nosocomial deaths were classified as death group(20.7%),and discharge and recovery were required as nosocomial survival group(79.3%).There was no significant difference in age,sex,smoking and drinking between the two groups.The time to hospital and systolic blood pressure level of the nosocomial death group was lower than those of the survival group,and there was no significant difference between the two groups in terms of complications and previous medical history.The mean distribution width and platelet level of leukocytes,neutrophils,platelets;total carbon dioxide and uric acid;D-dimer,PT and FIB were significantly different between the two groups(P<0.05).There was no significant difference in blood type between the two groups.The diameter of the widest AAO in TTE the nosocomial death group was higher than that in survival roup,and the difference was significant.Multivariate binary Logistic regression analysis showed that the diameter of the widest part of AAO,>44.5mm,d-dimer >7.23mg/L,leukocyte >10.82 G/L,and failure of surgical treatment were independent risk factors for in-hospital death.Conclusions: 1.There are many differences between acute Stanford type A and B AD.When the patient is female,age <67 years old,admission systolic blood pressure <118mm Hg,the widest diameter of AAO>40.5mm,MPV>9.82 fl,d-dimer >7.13mg/L,the possibility of acute Stanford type A AD is more likely to be considered,which may be helpful for rapid clinical identification.In this way,medical workers can make a clear diagnosis of type A AD and prepare surgical treatment as soon as possible to reduce the fatality rate.The proportion of acute Stanford type B AD with renal cyst was significantly higher than that of type A,but further in-depth mechanism study was needed to explore this differences and explain what they mean.2.In patients with acute Stanford type A AD,when the widest part of AAO has a diameter of >44.5mm,d-dimer >7.23mg/L and leukocyte >10.82 G/L,the possibility of hospital death increases,requiring early surgical treatment,which can significantly reduce the hospital mortality.Part ?: Current status research of acute Stanford type A AD patients admitted to ICU with respiratory tract infection after surgical treatmentObjective: The clinical data of acute Stanford type A AD admission and postoperative ICU admission were analyzed.Statistical analysis was conducted on the postoperative specimen culture results,infection indicators,antibiotic use,ICU stay time,tracheal intubation days and prognosis,to find the distribution of postoperative pathogen infection,the influencing factors of infection,the correlation between infection and prognosis,and the current situation of antibiotic use.Methods: Retrospective analysis of 219 patients with acute Stanford type A AD hospitalized in our center from September 2017 to October 2018,except for 2 cases of subacute and chronic aortic dissection(from onset to visit time >336 hours),3 cases of repeated hospitalization and 1 case of incomplete data,213 cases were included.Among the 213 cases,162 cases of surgical treatment and 51 cases of conservative treatment.162 cases of surgical treatment were included in the group,and an Excel spreadsheet was created,the data was entered and imported into the SPSS system,statistical analysis was performed using SPSS 25.0 software.Results: 162 cases of acute Stanford type A AD after surgery were admitted to ICU with sputum culture for every patient,including 87 cases(53.7%)in the sputum culture positive group and 75 cases(46.3%)in the sputum culture negative group.The level of triglyceride in the positive group was higher than that in the negative group,and the level of high-density lipoprotein was lower than that in the negative group(P<0.05).There were no significant differences between the two groups in age,gender,admission signs and complications,previous medical history,extracorporeal circulation time and operation time,other laboratory examinations,postoperative blood routine and biochemical examination and postoperative ICU admission(P>0.05).Postoperative admission to cardiac macrovascular surgery ICU sputum culture detected bacterial distribution were 60 acinetobacter baumannii(39.7%,CRAB 8.3%),37 staphylococcus aureus(24.5%,MRSA 89.2%),25 klebsiella pneumoniae(16.6%,producing ESBLs strains 44.0%),12 escherichia coli(7.9%,producing ESBLs strains 50.0%,CRE 16.7%),8 pseudomonas aeruginosa(5.3%,CRPA 25.0%)were the most common five.The distribution of fungi were as follows: 30 candida albicans(51.7%),13 candida tropialis(22.4%),6 candida lucidum(10.3%),4 candida lucidum(6.9%),3 aspergillus flavus(5.2%)and 2 candida lucidum(3.4%).Carbapenems(67.3%),linezolid(58.6%),ceftriaxone(53.7%)and cefoperazole(54.9%)were the main antibiotics,followed by tegacycline(27.0%)and glycopeptide(13.0%).Antifungal drugs were fluconazole(24.1%),voriconazole(3.7%),and echinoctin(3.1%).Conclusion: The possibility of respiratory drug-resistant infection after acute Stanford type A AD in our center is mainly Acinetobacter baumannii,Staphylococcus aureus and Klebsiella pneumoniae;and fungi are Candida albicans,Candida tropicalis and Candida glabrata.Mainly,Carbapenems,cephalosporins and oxazolone antibiotics linezolid are widely used after acute Stanford type A AD,which may be the important reason for the distribution of resistant strains. |
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