2024 年第 7 期 第 0 卷

序贯器官衰竭评估评分最大值指导的急性A型主动脉夹层修复术后脏器管理

Organ management after surgical repair of acute type A aortic dissection guided by sequential organ failure assessment maximum

作者：张璿张喜维

英文作者：Zhang Xuan Zhang Xiwei

单位：首都医科大学附属北京安贞医院人力资源部，北京100029

英文单位：Human Resources Department Beijing Anzhen Hospital Capital Medical University Beijing 100029 China

关键词：急性A型主动脉夹层；序贯器官衰竭评估评分最大值；器官功能不全；主动脉术后脏器管理

英文关键词：AcutetypeAaorticdissection;Sequentialorganfailureassessmentmaximum;Organdysfunction;Organmanagementafteraorticsurgery

• 摘要：

• 目的 探索序贯器官衰竭评估评分最大值（SOFA Maximum）≥11与急性A型主动脉夹层（ATAAD）修复术后30 d心、脑、肺、肾、肝功能不全的独立相关性，进而评估SOFA Maximum指导ATAAD修复术后脏器护理的敏感性与独立性。方法 回顾性选取2023年8—12月于首都医科大学附属北京安贞医院行手术修复的ATAAD患者114例。应用多元逻辑回归方法探索SOFA Maximum≥11与ATAAD修复术后30 d器官功能不全代表性终点事件的独立相关性。结果 SOFA Maximum≥11与ATAAD修复术后30 d心脑功能不全（主要心脑血管不良事件）、肺功能不全（术后肺部并发症）、肾功能不全（急性肾损伤/衰竭）、肝功能不全（急性肝损伤/衰竭）均具有独立相关性（比值比分别为5.61、3.94、9.44、2.89，均P＜0.05）。结论 SOFA Maximum≥11用于指导ATAAD修复术后脏器护理具有良好的独立性与敏感性。未来将SOFA Maximum≥11纳入ATAAD修复术围手术期标准化管理体系，具有广阔的应用前景。

• Objective To explore the independent correlation between sequential organ failure assessment maximum (SOFA Maximum) ≥11 and heart, brain, lung, kidney and liver dysfunction at 30 d after acute type A aortic dissection (ATAAD) repair, and to evaluate the sensitivity and independence of SOFA Maximum in guiding organ care after ATAAD repair. Methods A total of 114 patients with ATAAD who underwent surgical repair in Beijing Anzhen Hospital, Capital Medical University from August to December 2023 were retrospectively selected. Multiple Logistic regression was used to explore the independent correlation between SOFA Maximum≥11 and the representative end point of organ dysfunction at 30 d after ATAAD repair. Results  SOFA Maximum≥11 was independently associated with cardio-cerebral insufficiency (major cardiovascular and cerebrovascular adverse events), pulmonary insufficiency (postoperative pulmonary complications), renal insufficiency (acute kidney injury/failure), and liver insufficiency (acute liver injury/failure) at 30 d after ATAAD repair (odds ratio=5.61，3.94，9.44，2.89, respectively, all P＜0.05). Conclusion  SOFA Maximum≥11 has good independence and sensitivity in guiding organ nursing after ATAAD repair. In the future, SOFA Maximum≥11 will be included in the standardized perioperative management system of ATAAD repair, which has broad application prospects.