急性Stanford A型主动脉夹层并发急性心包填塞相关危险因素分析

Related risk factors analysis of acute type A aortic dissection complicated by cardiac tamponade

目的探讨急性Stanford A型主动脉夹层（AAAD）患者并发急性心包填塞（TMP）相关危险因素、临床特点及64排CT特征，以便早期识别高危患者．坪减少该并发症的发生。方法回顾性分析2006-01～2011—12收治的AAAD患者共320例的临床资料，入院后在AAAD急性期内并发’FMP1者52例。采用Logistic回归模型分析AAAD患者并发TMP的独立危险因素。结果AAAD并发TMP的中位数时间为2．5d。与非TMP组相比，TMP组就诊时间更早，入院时收缩压、超敏C反应蛋白较低（P〈0．01）；TMP组就诊时心率（ttR）〈70次／min、就诊时HR≥100次／min、心包积液、疼痛症状再发的发生率较高（P〈0．01）；TMP组自细胞总数、超敏肌钙蛋白I、D-二聚体（D—dimer）、随机虹糖较高（P〈0．01，P〈0．05）。64排CT结果显示，与非TMP组相比，TMP组升主动脉出现破口的比例更高，升主动脉假腔内血栓形成的比例更少（P〈0．05）。应用Logistic同归分析前进法确定AAAD并发TMP的独立危险斟素包括较早的就诊时间（P=0．006）、就诊时较低的收缩压（P=0．011）、就诊时过快或过慢的HR（P=0．010）、就诊时较高的D—dimer（P=0．035），心包积液（P=0．030）和再发疼痛症状（P=0．007）。TMP组的院内病死率达86．5％。结论AAAD发病早期、就诊时较低的收缩压与过快或过慢的HR、D-dimer升高、心包积液以及再发疼痛症状是AAAD并发TMP的独立危险凶素。

Objective To analyze the related risk factors of acute type A aortic dissection （AAAD） complicated by cardiac tamponade （TMP） and to define the independent risk factors for cardiac tamponade. Methods Clinical and multi -slice computed tomography scan （MSCT） data of 320 AAAD patients admitted to our department from January 2006 and December 2011 were retrospectively reviewed, TMP was confirmed in 52 patients by examination. Multivariate Logistic regression analysis was performed to identify risk tactors for TMP. ResuLts TMP occurred in median of 2.5 days after symptom onset. Risk factors associated with TMP were early stage of AAAD, lower systolic pressure and lower or higher heart rate at admission, hydropericardium, increased D - dimer level and symptom recurrence, in- hospital mortality of TMP was very high （86.5%）. Conclusion Early stage of AAAD, lower systolic pressure and lower or higher heart rate at admission, increased D - dimer level, hydropericardium and symptom recurrence are independent factors of AAAD complicated by TMP.