A 型主动脉夹层修复术后患者的血压和心率管理

IF 3.6 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Annals of Thoracic Surgery Pub Date : 2025-03-06 DOI:10.1016/j.athoracsur.2025.02.012

Chun-Hung Ho, Chia-Pin Lin, Feng-Cheng Chang, Chun-Yu Chen, Yu-Ting Cheng, Ying-Chang Tung, Yi-Hsin Chan, Victor Chien-Chia Wu, Pao-Hsien Chu, Shao-Wei Chen

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引用次数: 0

摘要

背景：急性A型主动脉夹层（TAAD）术后患者血压和心率的长期最佳目标尚不清楚。本研究旨在评估taad手术修复后患者血压和心率控制的长期关系。方法：我们从2003年至2018年的Chang gong研究数据库中确定了839例接受TAAD手术修复并存活至出院的患者。主要结局包括全因死亡率、主动脉进展和主动脉手术事件。出院时和随访3个月时的生命体征为收缩压（SBP）、舒张压和心率（HR）。结果：患者平均年龄57.2±13.6岁，约三分之二为男性。结果显示，出院时收缩压低于150 mmHg与全因死亡率升高相关(校正风险比[aHR] 3.21；95%置信区间[CI] 1.61-6.37)。此外，心率在81 - 100 bpm之间与较高的全因死亡风险相关(aHR 2.59；95% CI 1.28-5.24)和HR bbb100 bpm也与主动脉手术事件的高风险相关(aHR 2.19；95% CI 1.24-3.86)，而出院时HR≤80。在3个月的随访中，HR bbb100 bpm与较高的全因死亡风险相关(aHR 3.59；95% CI 1.19-10.78)相对于HR≤80。结论：仔细控制血压和HR有助于TAAD术后患者获得良好的长期预后。

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Blood Pressure and Heart Rate Management in Patients After Repair of Type A Aortic Dissection.

Background: The long-term optimal targets for blood pressure and heart rate in patients after surgical repair of acute type A aortic dissection (TAAD) remain unclear. This study evaluated the long-term association of blood pressure and heart rate control on patients after TAAD surgical repair.

Methods: We identified 839 patients who underwent TAAD surgical repair and survived to discharge between 2003 and 2018 from the Chang Gung Research Database. Primary outcomes included all-cause mortality, aortic progression, and aortic surgery events. Vital signs examined were systolic blood pressure (SBP), diastolic blood pressure, and heart rate (HR) at discharge and at 3 months of follow-up.

Results: The patients were a mean age of 57.2 ± 13.6 years, and approximately two-thirds were men. The results showed that SBP >150 mm Hg at discharge was correlated with increased all-cause mortality (adjusted hazard ratio [aHR], 3.21; 95% CI, 1.61-6.37). Moreover, an HR between 81 and 100 beats/min was associated with a higher hazard of all-cause mortality (aHR, 2.59; 95% CI, 1.28-5.24) and an HR >100 beats/min was also associated with a higher hazard of aortic surgery events (aHR, 2.19; 95% CI 1.24-3.86) compared with an HR of ≤80 beats/min at discharge. During the 3-month follow-up, an HR >100 beats/min was associated with a higher hazard of all-cause mortality (aHR, 3.59; 95% CI, 1.19-10.78) relative to an HR ≤80.

Conclusions: The careful management of blood pressure and HR contributes to favorable long-term outcomes in patients after surgical repair of TAAD.

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来源期刊

Annals of Thoracic Surgery 医学-呼吸系统

CiteScore

6.40

自引率

13.00%

发文量

1235

审稿时长

42 days

期刊介绍： The mission of The Annals of Thoracic Surgery is to promote scholarship in cardiothoracic surgery patient care, clinical practice, research, education, and policy. As the official journal of two of the largest American associations in its specialty, this leading monthly enjoys outstanding editorial leadership and maintains rigorous selection standards. The Annals of Thoracic Surgery features: • Full-length original articles on clinical advances, current surgical methods, and controversial topics and techniques • New Technology articles • Case reports • "How-to-do-it" features • Reviews of current literature • Supplements on symposia • Commentary pieces and correspondence • CME • Online-only case reports, "how-to-do-its", and images in cardiothoracic surgery. An authoritative, clinically oriented, comprehensive resource, The Annals of Thoracic Surgery is committed to providing a place for all thoracic surgeons to relate experiences which will help improve patient care.