Analysis Of The Effect And Mortality Risk Factors Of Continuous Renal Replacement Treatment Post Acute Stanford Type A Aortic Dissection Surgery

Objective : The clinical data of patients with acute Stanford A aortic dissection who underwent continuous renal replacement treatment(CRRT)after thoracotomy assisted by cardiopulmonary bypass were analyzed retrospectively.To summarize and analyze the risk factors of clinical death and the effect of CRRT.The purpose of this study is to provide clinical guidance and improve the prognosis of patients with acute Stanford A aortic dissection treated by CRRT in the future.Method : From January 2016 to April 2019,patients with acute Stanford type A aortic dissection who received CRRT after operation were selected from cardiovascular surgery department of the Affiliated Hospital of Qingdao University.After strict screening,65 patients were selected for this study.According to whether there was clinical death,the patients were divided into observation group(32 cases)and control group(33 cases).The age,gender,BMI index,related history,previous history,preoperative echocardiography report,operation mode,cardiopulmonary bypass data,intraoperative blood loss,blood loss within24 hours after operation,intraoperative blood transfusion,postoperative secondary endotracheal intubation,postoperative secondary thoracotomy hemostasis,postoperative complications and other clinical data of the two groups were analyzed retrospectively.The clinical data of lactate,urea nitrogen,creatinine,transaminase,bilirubin and oxygenation index before and after CRRT were analyzed retrospectively.SPSS 25.0 software was used for data analysis.The measurement data between the two groups were compared by t-test,and the counting data were compared by chi square test or Fisher precision test.Paired sample t test was used to compare the data before and after CRRT.To analyze the independent mortality risk factors of continuous renal replacement treatment post acute Stanford type A aortic dissection surgery,we used multivariate Logistic regression analysis.Result:Of the 65 patients included in this study,40 were male and 25 were female.The minimum age is 39,the maximum age is 78,and the average age is(55.03 ± 11.03).The mean hospital stay was(28.25 ± 22.46)days,the mean ventilator assist time was(10.25 ±12.68)days,and the mean CRRT time was(5.48 ± 7.52)days.The blood lactate value,urea nitrogen value,blood creatinine value and oxygenation index of patients after CRRT were significantly improved compared with those before treatment,and the indexes at each timepoint after treatment were better than those before treatment.Transaminase and bilirubin levels in patients after CRRT were not significantly lower than those before treatment.Of the65 patients,32(49.23%)died clinically,11 died of multiple organ failure,9 died of septic shock,4 died of low cardiac output syndrome,2 died of malignant arrhythmia,3 died of stroke,2 died of gastrointestinal hemorrhage,1 died of distal pseudolumen rupture.Univariate analysis showed that preoperative malperfusion,intraoperative blood loss,cardiopulmonary bypass time,deep hypothermia circulatory arrest time,drainage within 24 hours after operation,postoperative sepsis,postoperative acute liver dysfunction,and postoperative low cardiac output syndrome were the mortality risk factors of continuous renal replacement treatment post acute Stanford type A aortic dissection surgery.Multivariate Logistic regression analysis showed that postoperative sepsis and postoperative acute liver dysfunction were independent mortality risk factors of continuous renal replacement treatment post acute Stanford type A aortic dissection surgery.Conclusion:CRRT can alleviate the symptoms of patients with acute renal injury,hypoxemia and internal environment disorder after surgical treatment of acute Stanford type A aortic dissection,but it is less effective for patients with acute liver dysfunction.The prognosis of patients with acute Stanford type A aortic dissection treated with CRRT was related to multiple factors.Patients with postoperative sepsis and acute liver dysfunction are more likely to die.The prognosis of patients should be improved by paying attention to the protection of liver function during perioperative period and the prevention of perioperative infection.