急性期保守治疗的Stanford B型主动脉夹层患者死亡原因分析

Analysis of death-related factors of type B aortic dissection treated medically during the acute phase

目的分析保守治疗的急性StanfordB型主动脉夹层患者急性期（发病14d内）的死亡相关因素，指导急诊手术病例的选择。方法回顾分析2007年1月至2009年5月进行保守治疗的42例急性Stanford B型主动脉夹层患者，其中男性33例，女性9例，平均年龄（50±12）岁。治疗方法包括止痛、控制性降压及抑制心肌收缩等对症治疗。其中急性期存活28例，死亡14例，分别应用单因素和多因素Logistic回归分析寻找其急性期死亡的相关因素。结果在单因素Logistic回归分析中，分支血管缺血（P=0．018）和主动脉最大径（P=0．002）是急性期B型夹层的死亡相关因素；多因素Logistic回归分析亦证实分支血管缺血（P=0．041）和主动脉最大径（P=0．005）为死亡的相关因素。当主动脉最大径超过40／13m时死亡风险明显增高（P=0．000）。结论存在主动脉分支血管缺血或主动脉最大径〉40mm的急性StanfordB型主动脉夹层患者应考虑急诊手术或腔内治疗。

Objective To analyze the death-related risk factors of type B aortic dissection treated medically during the acute phase （ symptoms presenting within 14 d ）, and to determine the predictors of surgical indications for acute type B aortic dissection. Methods Clinical data of 42 patients with acute type B aortic dissection admitted from January 2007 to May 2009 was retrospectively reviewed. There were 33 male and 9 female with a mean age of （50 ± 12） years old. Therapy included analgesia, controlled hypotension and β-receptor blocker, the mortality in acute phase was 33.3% （14/42）. Univariate and multivariate logistic regression analyses were performed to identify the predictors of the death in acute phase. Results In univariate logistic regression analysis, the malperfusion of aortic branches （P =0. 018） and maximum aortic diameter （P = 0. 002） were significant predictors of death. In the multivariate logistic regression model, the malperfusion of aortic branches （ P = 0. 041 ） and maximum aortic diameter （ P = 0. 005 ） were also considered as the significant death-related factors. Risk of death augmented significantly （ P = 0. 000 ） when the maximum aortic diameter over 40 ram. Conclusion Malperfusion of aortic branches and the large maximum aortic diameter （ 〉 40 ram） are the indications of surgery or endovascular therapy for acute type B aortic dissection.