126例急性A型主动脉夹层临床特征分析

Clinical characteristics of acute type A aortic dissection:an analysis of 126 cases

目的分析急性A型主动脉夹层（acutetype Aaorticdissection，AAAD）的临床特征，探讨住院死亡的危险因素，以提高对本病的诊治水平。方法回顾性分析2008年4月至2012年12月确诊的126例AAAD患者的临床资料，分析AAAD的发病特征，首诊症状及误诊情况。根据临床结局将患者分为存活组及死亡组，比较两组间临床特征差异并经多因素回归分析筛选AAAD患者住院死亡的危险因素。结果43例保守治疗，25例死亡，住院病死率为58．1％，83例接受手术治疗，12例死亡，术后病死率为14．5％。AAAD发病具有季节性，发病年龄集中在56—60岁，不同性别及不同年份的发病年龄无明显差异。AAAD临床表现复杂，误诊率为7．2％，胸痛是AAAD最常见的首诊症状。存活组与死亡组患者在白细胞总数，丙氨酸氨基转移酶（ALT）、天冬氨酸氨基转移酶（AST）、肌酐值上差异有统计学意义。多因素回归分析提示肌酐值〉132μmol／L与心包填塞是AAAD患者住院死亡的危险因素。结论肌酐值〉132μmol／L与心包填塞是AAAD患者住院死亡的危险因素。正确认识AAAD的临床特征，早期预防、及时诊断、有效处理危险因素是降低AAD患者死亡率的关键。

Objective To improve the diagnosis and treatment of acute type A aortic dissection （AAAD） by analyzing its clinical characteristics and risk factors of in-hospital mortality. Methods From April 2008 to December 2012, the clinical data of 126 AAAD cases were retrospectively analyzed. The clinical characteristics, the first clinical symptom and misdiagnosis were analyzed. Patients were divided into two groups according to the clinical endpoints. The clinical characteristics were compared between groups and multiple logistic regression was carried out to screen the risk factors of in-hospital mortality. Results A total of 25 patients died in the 43 patients with conservative treatment, and the in-hospital mortality was 58.1%. In the 83 eases of surgical treatment, 12 patients died and the postoperative mortality was 14.5%. The onset of AAAD displayed seasonal variation, incidence reached its peak at 56 to 60 yeats of age. The age of onset was similar between different sex and years. Clinical manifestation of AAAD was diverse with a misdiagnosis rate of 7.2% ,and chest pain was the most common symptom of AAAD. Significant differences were observed in total leucocyte amounts, alanine aminotransferase, aspartate trans- aminase, and creatinine between survivors and the dead. Abnormal creatinine （ 〉 132 μmol/L）and cardiac tamponade were proved to be the risk factors of in-hospital mortality by multiple logistic regression. Conclusion Thorough understanding the clinical characteristics of AAAD with early prevention, correct diagnosis and management of risk factors effectively is critical to decrease the mortality of AAAD patients.