358例主动脉夹层发病危险因素、临床特点及预后分析

Retrospective analysis of risk factors,clinical symptoms and prognosis in 358 cases with aortic dissection

目的探讨主动脉夹层(AD)的发病危险因素、临床特点及预后。方法收集并回顾性分析新疆医科大学第一附属医院2005年9月-2013年1月收治并确诊的358例主动脉夹层患者临床资料。结果主动脉夹层发病年龄呈正态分布,平均年龄为(51.65±11.71)岁,发病患者中男女比例为2.59∶1,249例患者出院诊断合并高血压病(69.55%),116例患者有明确的大量吸烟史(32.40%),201例具有典型疼痛症状(56.15%)。DeBakeyⅠ、Ⅱ、Ⅲ型夹层构成比分别为24.86%、12.57%和57.82%,不典型夹层壁间血肿占4.75%。Stanford A型患者住院死亡率(28.70%)高于Stanford B型患者(3.10%)(P<0.05)。结论血压控制不良为主动脉夹层主要发病危险因素,临床特点为剧烈疼痛,内科保守治疗是基础。及时正确诊断及积极采取相应措施是降低AD病死率和改善预后的关键。

Objective To investigate the risk factors,clinical symptoms and prognosis of Aortic Dissection （AD）,providing the clue to recognize the disease early and treat it promptly.Methods We analyzed ret-rospectively 358 patients with AD from September,2005 to January,2013 in the First Affiliated Hospital of Xinj iang Medical University.Results The ages of first-attack were in accordance with the normal distri-bution.The mean age was （51.65±11.71）,and male/female ratio was 2.59 to 1,hypertension was present in 69.55% of all the patients.Heavy smoking history was elicited in 32.40% of all the patients.201 patients was recognized with typical pain（56.15%）.Type I dissection were identified in 24.86% of all the cases. 12.57% in type II,57.82% in type III,and 4.749% in intramural hematoma.In-hospital mortality of type A （28.7%）was higher than that of type B （3.1%）（P 〈0.05）.Conclusion Hypertension is the primary risk factor of AD.Conservative treatment is the basis for treatment of AD.Timely,accurate diagnosis and active,ap-propriate treatment are the key to decrease the in-hospital mortality and to improve the prognosis of AD.