Analyzing variations and clinical significance of perioperative serum inflammatory indicators in patients undergoing acute aortic dissection repair / 中华外科杂志

ABSTRACT

<p><b>OBJECTIVES</b>To study perioperative inflammatory response status in patients with acute aortic dissection. To analyze the reason and outcome of the inflammatory activation.</p><p><b>METHODS</b>Between August 2011 and December 2011, 30 patients (22 male and 8 female, mean aged (43 ± 9) years) had undergone open repairs of aortic dissection or aneurysm with deep hypothermic circulatory arrest. Indications for surgical intervention were type A aortic dissection in 26 patients and aortic aneurysm in 4 patients. In detail, ascending aorta and arch replacement combined with stent elephant trunk were done in 29 patients, arch replacement combined with stent elephant trunk in 1 patient. According to the time from clinical onset of the dissection to operation, acute group (less than 7 days, group A) 20 patients, chronic group (more than 30 days and aortic aneurysm, group C) 10 patients. White blood cell, C-reactive protein and procalcitonin were assayed before and after operation. These valuables were recorded and compared statistically between two groups.</p><p><b>RESULTS</b>There were no significant differences in age, operation time, and blood transfusion volume (P > 0.05). Preoperative serum level of inflammatory indicators in group A were significant higher than in group C (t > 3, P < 0.05). Postoperative serum peak level of these indicators were significant higher than preoperative level in both groups (t > 4, P < 0.05). There were much more complications occurred on patients in group A (21 cases) than in group C (0 cases). The occurrence of early postoperative complications in group A was much higher than group C (χ(2) = 12.209, P = 0.000). Mechanic ventilation time in group A and group C were (35 ± 58) hours and (18 ± 9) hours respectively. ICU length of stay in two group were (49 ± 61) hours and (33 ± 12) hours, respectively. The patients with mechanic ventilation time more than 24 h, ICU length of stay more than 5 days in group A was more than in group C significantly (χ(2) = 5.161, P = 0.010; χ(2) = 3.657, P = 0.024).</p><p><b>CONCLUSIONS</b>Acute aortic dissection and surgical procedure induce an acute phase inflammatory reaction. The patients with acute aortic dissection involved more serious organic injury and worse outcome following surgery compared with chronic aortic dissection.</p>