36例Stanford B型主动脉壁间血肿的临床诊治分析

Analysis of 36 patients with type B aortic intramural hematoma： clinical presentations, treatments and outcomes in a single center

目的 通过分析总结B型主动脉壁间血肿（IMHB）的临床特点,探讨该病的治疗时机和方法.方法 回顾性分析武汉市协和医院2008年1月至2013年12月收治的36例B型主动脉壁间血肿患者的临床资料,总结该病的流行病学特点、临床表现、误诊误治、治疗方式及预后,分析比较不同治疗方式的疗效及远期生存率.结果 36例IMHB患者的发病年龄（60.19±11.12）岁,男26例,女10例.大部分患者表现为急性胸背部疼痛,且有高血压病史.28例患者接受了药物保守治疗（77.78％）,共死亡5例（17.86％）；8例患者接受了腔内支架治疗（22.22％）,死亡1例,死亡原因脑溢血；保守治疗和腔内支架治疗的死亡率比较差异无统计学意义.结论 单纯的B型主动脉壁间血肿可行药物保守治疗,住院期间每周进行影像学检查,一旦发现血肿进行性增厚或者形成典型的夹层,则应立即外科干预.

Objective To review the clinical manifestation, diagnosis method, misdiagnosis, risk factors, treatments and prognosis of Stanford B aortic intramural hematoma （IMHB）. Methods All of the Stanford B aortic IMHB patients admitted in Wuhan Union hospital from January.2008 to December 2013 were analyzed. The clinical manifestation, diagnosis method, misdiagnosis, managements and prognosis were studied. Furthermore, the effect and long-term survival of different therapies were compared, including medical treatment and endovascular repair. The statistics was performed with SPSS 16. 0. Results There were 36 B aortic IMHB pa- tients, and the percent of male patients was 72. 22%. The mean age of IMHB was 60. 19 ± 11.12. Most patients complained of acute chest and back pain, accompanied with hypertension. Twenty-eight patients （77..78%） received medication therapy, among them, there were 5 patients died of aortic rupture; eight patients （22. 22% ） received endovascular surgery, one died of cerebral hemorrhage （ 12. 5% ）. No difference was found between medication therapy and endovascular surgery （ 17.86% vs 12. 5%, P 〉 0. 05）. Conclusions For simple type B aortic IMHB patients, medication therapy and a dynamic monitoring of full aortic CT angiography was recommended, and for pejorative patients the endovascular treatment should be taken actively.