主动脉夹层232例流行病学调查研究

Epidemiological studies of 232 cases of aortic dissection

目的回顾性分析总结主动脉夹层住院患者的流行病学特征和临床特征。方法对2003—2013年符合主动脉夹层诊断的232例患者的一般情况、发病时间、临床症状与体征、诊断与延误诊断及治疗情况进行回顾性分析。计数资料比较采用χ^2检验,P〈0.05为差异有统计学意义。结果 232例患者中,男171例,女61例,年龄（58.21±12.24）岁,分为A型91例,B型141例。以1、2、11、12月发病率最高,4个月中A型发病例数占总例数的51.65%,B型发病例数占总例数的53.90%。A型患者胸痛、胸闷心悸、晕厥及神志模糊等症状发生率（74.73%、23.08%、12.09%）明显高于B型（18.44%、9.93%、3.55%,均P〈0.05）,B型患者主要表现为肩背部疼痛（42.55%）,与A型（21.98%）相比差异有统计学意义（P〈0.05）。A型患者的低血压或休克、双侧肢体血压不对称、主动脉瓣区舒张期杂音、心包积液、心包填塞、急性心肌梗死、心电图改变（13.19%、39.56%、24.18%、23.08%、4.40%、6.59%、64.84%）的发生率高于B型患者（4.26%、17.02%、6.38%、4.96%、0、0、43.26%）,两组比较差异均有统计学意义（均P〈0.05）。经内科治疗后,好转率78.02%,病死率16.38%,未愈、放弃占5.60%,转心外科行带膜支架治疗占11.21%,行外科手术治疗占5.60%。结论主动脉夹层患者发病年龄多在50~70岁;男性多于女性;冬春季为高发季节;疼痛是主要的首发症状,可伴有心包积液、四肢血压异常、晕厥及意识障碍等症状和体征;及时结合CT、MRI、UCG等影像学检查,可大大提高诊断率,正确诊断和积极的内科治疗以及根据临床分型和病情采取外科手术、介入治疗可减少病死率和改善患者的预后。

Objective This paper was to analyze retrospectively the epidemiological characteristics and clinical features of aortic dissection. Methods A total of 232 cases of confirmed aortic dissection in 2003-2013 were retrospectively analyzed for their general condition,time of symptom onset,clinical signs and symptoms,diagnosis and delay in diagnosis,and treatment. Count data were processed by chi-square test,the result of P〈0. 05 indicated the difference was statistically significant. Results Of the 232 cases,171 were male,61 female,with the age of（ 58. 21 ± 12. 24 mm）,and there were91 cases of type A,141 cases of type B. The incidence reach the highest in January,February,November and December.During the four months,cases of type A accounted for 51. 65%,and type B for 53. 90%. The incidence of chest pain,chest tightness,palpitations,syncope and unconsciousness was obviously higher in cases of type A than in those of type B（ P〈0. 05）. Back pain and abdominal pain were main symptoms in cases of type B,which was significantly different from those of type A（ P〈0. 05）. The incidence of hypotension,shock,bilateral asymmetric limb blood pressure,aortic diastolic murmur,pericardial effusion,cardiac tamponade,acute myocardial infarction,electrocardiogram changes and Marfan syndrome was higher in cases of type A than in those of type B. The difference was statistically significant（ P〈0. 05）.After medical treatment,78. 02% got improved,16. 38% died,5. 60% showed no response and abandoned the treatment,11. 21% were referred to the department of cardiosurgery for stent therapy,and 5. 60% received surgical treatment. Conclusions Aortic dissection typically occurred in patients aged 50-70 years,men were more likely to be affected than women,its peak onset mainly occurred in winter and spring,pain was the first sign and usually accompanied by pericardial effusion,abnormal blood pressure,syncope,and unconsciousness. CT,MRI,UCG and other imaging examination can greatly improve the accuracy of diagnosis. Accurate diagnosis,active medical treatment,and surgical and interventional therapy based on clinical classification can reduce mortality and improve the prognosis.