113例急性主动脉夹层患者临床特征及其相关性分析

Clinical features and the correlations between the prognosis and clinical changes in 113 cases with acute aortic dissection

目的 分析急性主动脉夹层患者的临床特征、相关并发症的发生和影响其临床预后的危险因素.方法 回顾性分析113例急性主动脉夹层患者的临床资料、临床特征及住院期间病情变化和预后的相关性.结果主动脉夹层发病的平均年龄（50.1±11.2）岁,男女比例6.5∶ 1.0,最多见症状为胸痛（占70.8%）.Stanford A型夹层的患者发病至就诊时间（50.1±8.3）h、平均年龄（44.6±8.1）岁、入院时血压（142.6±43.5/68.3±25.0）mm Hg与既往有高血压史的病例比率（53.3%）均少于Stanford B型,分别为（112.3±9.8）h、（52.0±12.8）岁、（159.0±36.4/92.5±22.7）mm Hg和73.5%（P〈0.05）;Stanford A型动脉夹层合并马凡综合征患者比率（13.3%）及死亡率（33.3%）高于B型（分别为0和9.6%;P〈0.05）;心包积液和意识障碍的发生率也高于B型（P〈0.05）.结论 主动脉夹层多发生于中壮年男性,冬季发病率较高.A型主动脉夹层的就诊时间早,发病年龄相对年轻,心包积液和意识障碍的发生率和死亡率均高.出现心包积液、胸腔积液及Stanford分型为A型是预测死亡的独立指标.

Objective To analyze the clinical features, related complications and risk factors affecting the prognosis in the patients with acute aortic dissection. Methods The clinical data of 113 patients with acute aortic dissection were retrospectively analyzed with statistical method. Their clinical features, relationship between the prognosis and clinical changes were described. Results The mean age was （50.1±11.2） years old in all the patients,the majority of whom were men,with the ratio of a male to female 6.5： 1.0. Chest pain was the typical main symptom（ occurred in 70.8% patients）. The time from onset to consult （ 50. 1 ± 8.3 ） hours, mean age （ 44.6 ± 8. 1 ） years old, blood pressure at admission（ 142.6 ±43.5/68.3±25.0）mm Hg and hypertension history （53.3%） of Stanford type A were less （or shorter） than those of type B[ （ 112.3 ±9.8） hours, （52.0 ± 12.8） years old, （ 159.0 ± 36.4/92.5 ± 22.7 ） mm Hg and 73.5% respectively, P 〈 0.05 ] ; but history of Marfan syndrome （ 13.3% ）, and mortality （33.3%） of Stanford type A were higher than those of type B （0 and 9.6% , respectively ; P 〈 0.05 ） ; the incidences of pericardial effusion and conscious disturbance in type A were higher than those of type B （ P 〈 0.05 ）. Conclusion The most patients with acute aortic dissection were in the prime or middle - aged of life and the morbidity was higher in winter. The patients with Stanford type A were younger and consulted early, but had higher mortality and incidences of pericardial effusion and conscious disturbance compared with type B. Pericardial effusion, conscious disturbance and Stanford type A were independent predictors of death.