| Objective: Aortic dissection is a dangerous disease,and Stanford type A aortic dissection is the most dangerous.Surgery for Stanford type A aortic dissection need the support of cardiopulmonary bypass.Gastrointestinal bleeding(GIB)after cardiopulmonary bypass is a complication with low incidence but high mortality.In the early stage,because there is no specific symptom,it is difficult to diagnosis.In this study,data of patients who underwent surgery for Stanford type A aortic dissection were collected and analyzed to explore the risk factors for GIB after surgery for Stanford type A aortic dissection,so as to provide some clues for early diagnosis and treatment.Methods: Data of patients with Stanford type A aortic dissection admitted to Tongji Hospital(affiliated to Huazhong University of Science and Technology)from January 2015 to June 2019 were collected and analyzed retrospectively to explore the risk factors of GIB after surgery for Stanford type A aortic dissection.We divided the patients into the bleeding group,the non-bleeding group,the occult blood positive group and the progress group according to whether and when they had positive fecal occult blood and the symptoms of gastrointestinal bleeding.The data was analyzed with SPSS 23.0.The continuous variables were expressed by mean ± standard deviation or median and quartile spacing,and analyzed by T test or Mann-Whitney U test;the count data was expressed by number of cases and percentage and analyzed by chi-square test or fisher exact test.Multivariate logistic regression was used to analyze the variables to explore the correlation between each factor and prognosis.P<0.05 shows significant difference among the variables.Results: A total of 406 patients were included in this study,among 37 with positive fecal occult blood only,20 with massive gastrointestinal bleeding,and the incidence was 9.11% and 4.93% respectively,the mortality of the later was 60%.Variables which is statistically significant difference between bleeding group(n = 57)and non-bleeding group(n = 349)included: age [(53 ± 10.4)vs(49.5 ± 10.9)years,p = 0.024],BMI [(25.6 ± 3.2)vs(24.3 ± 4)kg/m2,p = 0.023],incidence of preoperative e GFR < 60 m L/min/1.73m2(28.1% vs 15.2%,p = 0.016),incidence of emergency surgery(52.6% vs 38.7%,p = 0.047),incidence of aorta arch replacement(59.6% vs 43.8%,p = 0.026),cardiopulmonary bypass time [(226.5 ± 54.5)vs(194.2 ± 52.2)min,p < 0.001],postoperative red blood cells infusion volume [15(10-24)vs 8(4.75-12.75)U,p < 0.001],postoperative plasma infusion volume [1850(1125-3125)vs 750(300-1450)ml,p < 0.001],incidence of 3 or more type of inotropic agents used postoperatively(56.1% vs 20.6%,p<0.001),incidence of postoperative pulmonary infection(66.7% vs 41.5%,p < 0.001),incidence of postoperative ALT/AST > 2 upper limit of normal(54.4% vs 26.6%,p < 0.001),the need of postoperative continuous renal replacement therapy(29.8% vs 4%,p < 0.001),incidence of postoperative blood glucose > 11.1mmol/L(29.8% vs 16.9%,p = 0.02),incidence of postoperative platelet count < 50×109/L(31.6% vs 6.3%,p < 0.001),incidence of feeding or enteral nutrition within 24 hours after operation(17.5% vs 37%,p = 0.004).Multivariate logistic regression analysis showed that postoperative plasma infusion volume > 1000ml(OR = 3.138,95%CI: 1.528-6.443,p = 0.002),3 or more type of inotropic agents used(OR = 2.921,95%CI: 1.505-5.67,p = 0.002),the need of continuous renal replacement therapy postoperative(OR = 6.025,95%CI: 2.47-14.7,p < 0.001),and postoperative platelet count < 50×109/L(OR = 2.712,95%CI: 1.184-6.209,p = 0.018)were independent predictors for the occur of GIB after surgery for Stanford type A aortic dissection.Variables which is statistically significant difference between progress group(n = 7)and the occult blood positive group(n = 37)were red blood cells infusion volume after occult blood positive [15(3.5-21)vs 3.5(0-8.5)U,p = 0.043),plasma infusion volume after the occult blood positive [1750(1200-2550)vs 700(0-1350)ml,p = 0.006),incidence of platelet count < 50×109/L after the occult blood positive(85.7% vs 32.4%,p = 0.013),incidence of 3 or more type of inotropic agents used after occult blood positive(100% vs 48.6%,p = 0.014).Conclusion: 1.Need continuous renal replacement therapy postoperative,postoperative platelet count < 50×109/L,3 types or more inotropic agents used postoperatively,and postoperative plasma infusion volume > 1000 ml are risk factors for GIB after surgery for Stanford type A aortic dissection.Which may suggest us to apply the following measures to reduce GIB and improve the prognosis for the patients with Stanford type A aortic dissection accepted surgery: paying attention to the patient who need continuous renal replacement therapy;transfusing platelet according to the situation of the patient whose platelet count is < 50×109/L;controlling postoperative blood glucose strictly;applying restrictive transfusion strategy and blood substitute to reduce the blood transfusion for postoperative patient.2.Most gastrointestinal bleeding after surgery for Stanford type A aortic dissection underwent a long process,and some patients showed fecal occult blood positive several days before massive bleeding.Fecal occult blood monitor may be an alarming index for postoperative gastrointestinal bleeding.With active intervention,patients with positive occult blood test may return to negative in the test and avoid massive bleeding. |
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