女性StanfordB型主动脉夹层患者的临床特征分析

Clinical features of female patients with Stanford B aortic dissection

目的:总结女性Stanford B型主动脉夹层患者的临床特征。方法:2002-04-2010-10期间入住沈阳军区总医院并接受药物保守治疗或主动脉腔内隔绝术治疗的Stanford B型主动脉夹层患者,按性别分为女性患者组(72例)及男性患者组(173例)。对2组患者的临床特征及住院期间结果进行回顾性分析。结果:女性组和男性组平均年龄无差异,但女性组≥60岁比例高于男性组(37.5%∶24.9%,P<0.05)。男性组吸烟比例高于女性组(16.8%∶2.8%,P<0.05)。2组糖尿病、冠心病、血脂异常比例无差异。主动脉夹层病因包括高血压、动脉粥样硬化溃疡、外伤、马方综合征、多发性大动脉炎,2组病因构成无统计学差异。女性组从出现症状到就诊时间≥24h者比例高于男性组(81.9%∶68.2%,P<0.05)。临床症状:包括胸背部刀割样或撕裂样疼痛、腹痛、下肢疼痛、呼吸困难、咯血、晕厥,2组患者不同临床症状构成比例及伴发胸腔积血、肾功能不全比例无统计学差异,女性患者表现为突发疼痛比例低于男性患者(73.0%∶85.4%,P<0.05)。女性组心功能不全及低氧血症者比例高于男性组(11.1%∶4.0%,33.3%∶20.2%,均P<0.05)。女性组接受药物保守治疗的比例高于男性组(27.8%∶8.7%,P<0.05)。住院期间2组各死亡2例,接受主动脉腔内隔绝术及药物保守治疗者分别各死亡1例,均考虑夹层破裂死亡。住院期间不同性别组及各组内不同治疗方法间死亡率无统计学差异。结论:女性主动脉夹层患者老年比例高于男性,临床症状不典型,就诊较晚,需提高警惕,以免延误诊治。对有适应证的女性Stanford B型主动脉夹层患者建议施行主动脉腔内隔绝术治疗。

Objective：To summarize the clinical features of female patients with Stanford B aortic dissection.Method：Retrospectively analyzed the clinical features and outcomes in hospital between the female patients（n=72） and the male patients（n=173） who were suffered from Stanford B aortic dissection and managed by medication or endovascular intervention between April 2002 and October 2010.Results：The average ages were similar in both groups while the proportion of patients ≥60 years was significantly higher in female group（37.5% vs 24.9%,P0.05）.Smoking was more common in male group（16.8% vs 2.8%,P0.05）.The proportions of patients accompanied with diabetes mellitus,coronary artery disease and hyperlipemia had no statistical significances between two groups.No significance occurred among constituent ratios of etiology including hypertension,penetrating atherosclerotic ulcer,trauma,Marfan＇s syndrome and polyarteritis in both groups.The female more often presented ≥24 h since appearance of symptoms（81.9% vs 68.2%,P0.05）.The incidences of chest and back pain like lance or tear,stomachache,lower limbs pain,dyspnea,hemoptysis,apopsychia and complications of hemothorax and renal inadequacy had no differences between both groups.The female presented with less frequent abrupt onset（73.0% vs 85.4%,P0.05）.Cardiac insufficiency and hypoxemia were more common in the females（11.1% vs 4.0%,33.3% vs 20.2%,P0.05）.The female were managed by medication more often than the male（27.8% vs 8.7%,P0.05）.2 patients died of aortic dissection in each group respectively,1 managed by medication and 1 with endovascular intervention.Hospital mortality was not statistically significant between both groups and between patients receiving different treatments in the same group.Conclusion：The elderly were more common in the female patients with Stanford B aortic dissection compared with the male.Emphasis should be exert on the female population lacking of classical symptoms and presenting later in order to avoid delay of diagnosis and treatment.Endovascular intervention was recommended to the appropriate female patients with Stanford B aortic dissection.