A型主动脉夹层入院时收缩压水平对住院死亡的影响

The Association between Systolic Blood Pressure Level on Admission and In-hospital Death in Patients with Stanford Type A Acute Aortic Dissection

目的探讨A型急性主动脉夹层患者入院时收缩压水平对住院死亡风险的影响。方法研究对象为2008年至2010年到阜外医院就诊经主动脉CT证实诊断为Stanford A型急性主动脉夹层患者共595例,收集患者的基线资料、入院时血压水平、治疗策略及其住院死亡情况。按患者入院时收缩压水平分为四组,比较住院死亡率及其影响因素。结果血压降低组(收缩压<90mmHg)的住院死亡率显著高于正常血压组(90mmHg≤收缩压<140mmHg)和血压轻度增高(140mmHg≤收缩压<160mmHg)及显著增高组(收缩压≥160mmHg)(45%vs.8.5%vs.9.7%vs.14.5%,P<0.05)。接受外科手术治疗患者中,血压降低组与其他组比较住院死亡率无显著差异(0%vs.0.5%,P>0.05),药物保守治疗患者中血压降低组住院死亡率显著高于其他组(81.8%vs.31%,P<0.05)。经多因素COX生存分析校正年龄和性别等因素后,入院时收缩压降低增加2.35倍的住院死亡危险(HR 2.35,95%CI 1.14-4.87,P=0.031),住院死亡的独立影响因素还包括基线血肌酐水平、白细胞计数、血小板计数及是否接受外科治疗。结论 A型主动脉夹层患者入院时的收缩压水平低于90mmHg时接受药物保守治疗的院内死亡风险较高,应尽早考虑接受外科手术治疗改善预后。

Objective To evaluate the association of systolic blood pressure（SBP） Icvelson admission with in-hospital death in patients with Stanford type A acute aortic dissection（AAD）.Methods This study enrolled 595 patients with Stanford type A AAD who were confirmed by aortic CT in Fuwai hospital from 2008 to 2010.We collected baseline clinical data and treatment strategies of all patients.The primary endpoint was in- hospital death.According to SBP levels on admission,all patients were divided into four groups,and inhospital mortality and influence factors were analyzed.Results The in-hospital mortality was significantly higher in the low SBP group（SBP≤90mmHg） than that in the normal SBP group（90mmHg ≤ SBP 40mmHg）,the increased SBP group（140mmHg≤ SBP160mmHg）,and the high SBP group（SBP ≥160mmHg）（45%vs.8.5%vs.9.7%vs.14.5%,P0.05）.In patients receiving surgical intervention,the inhospital inortality was similar between the low SBP group and the other groups（0%vs.0.5%,P 〈0.05）.In patients receiving conversational treatment with medicines,the in-hospital mortality was significantly higher in low SBP group than that in other groups（81.8%vs.31%,P0.05）.After adjustment for age,sex,and other factors by using multivariate COX regression analysis,the lowSBP on admission was significantly associated with increased risk of in-hospital death（OR 2.35,95%C1 1.14-4.87,P=0.03 1）.The in-hospital death was also independently associated with baseline scrum creatinine,white blood cell count,platelet count and surgical intervention.Conclusion Patients with Stanford type A AAD might be at high risk of in-hospital death if their SBP on admission was less than 90 mmHg.Those patients with low SBP level should receive surgical intervention soon instead of conversational treatment.