摘要目的:研究Stanford A型主动脉夹层(TAAD)全弓置换患者病死率与血管活性药物评分(VIS)的关系。方法:回顾性分析2018年1月至2018年11月期间收治的TAAD患者资料。根据纳入与排除标准，最终187例患者纳入分析。统计30天病死率，将患者分为死亡组(18例)和非死亡组(169例)。比较两组各时间点VIS、围术期指标，分析VIS预测死亡的价值。结果:本组病例30天病死率9.63%(18/187)。死亡组手术时间、体外循环、呼吸机辅助、气管切开、术后主要并发症发生率均明显高于非死亡组( P<0.05)。死亡组各时间点VIS均明显高于非死亡组( P<0.05)。各时间点VIS对死亡预测的受试者工作特征曲线下面积(AUC)均大于0.500( P<0.05)，其中ICU 48 h VIS的AUC最大(0.817)，并确定其最佳分界点为9，灵敏度61.1%，特异度92.3%。 Logistic回归分析显示，ICU 48 h VIS是TAAD全弓置换死亡的独立危险因素( OR＝1.465，95% CI：1.194～1.796， P<0.001)。 结论:ICU 48 h VIS≥9时TAAD全弓置换患者死亡风险增高，VIS或可成为术后早期预警TAAD全弓置换患者病死率的有利指标。

abstractsObjective:To study on the association between vasoactive-inotropic score(VIS) and mortality of total arch replacement in Stanford type A aortic dissection(TAAD) patients.Methods:Data of TAAD patients admitted from January 2018 to November 2018 were analyzed retrospectively. According to the inclusion and exclusion criteria, 187 patients were finally included in the analysis. 30-day mortality was calculated and the patients were divided into death group(18 cases) and non-death group(169 cases). The VIS at each time point and perioperative indexes of the two groups were compared. The value of VIS in predicting mortality was analyzed.Results:The 30-day mortality was 9.63%(18/187). The operation time, cardiopulmonary bypass time, ventilator assistance time, the incidence of tracheotomy and major postoperative complications in the death group were significantly higher than those in the non-death group( P<0.05). VIS of death group was significantly higher than that of non-death group( P<0.05). At each time point, the area under ROC curve(AUC) of VIS was greater than 0.500( P<0.05), among which AUC of ICU 48 h VIS was the largest(0.817), and the best cut-off point of ICU 48 h VIS was determined to be 9, sensitivity 61.1%, specificity 92.3%. Logistic regression analysis showed that ICU 48 h VIS was an independent risk factor for predicting the death of total arch replacement in TAAD patients( OR=1.465, 95% CI: 1.194-1.796, P<0.001). Conclusion:When ICU 48 h VIS≥9, the risk of death was increased in patients with total arch replacement of TAAD. VIS may be a useful reference index for predicting the mortality of total arch replacement in TAAD patients in the early postoperative period.