主动脉夹层院内死亡危险因素十年回顾性分析

Risk factors for hospital death in aortic dissection patients: a retrospective analysis of10 years

目的回顾性分析2004—2014年间主动脉夹层患者院内死亡的相关危险因素,对治疗时机及治疗方案的选择进行探讨,以对临床治疗提供依据。方法回顾分析2004年1月—2014年1月期间在武汉同济医院住院的主动脉夹层患者1 037例的临床资料,将患者分为死亡组和存活组,比较两组患者的一般情况及分析死亡的相关危险因素。结果十年期间主动脉夹层院内死亡107例（10.32%）,（53.23±10.37）岁,未死亡930例（89.68%）,（53.59±11.81）岁。死亡患者入院到死亡的天数（4.17±1.65）d,Logistic回归分析示入院时低血压（P=0.047,OR=1.378,95%CI：1.654~2.171）、脉搏快（P=0.031,OR=1.321,95%CI：1.003~1.039）、心包积液（P=0.016,OR=2.031,95%CI：1.147~3.619）、白细胞计数（P=0.018,OR=1.281,95%CI：1.013~1.162）和中性粒细胞比值增高（P=0.011,OR=1.269,95%CI：1.028~1.119）是主动脉夹层死亡的独立危险因素,入院后使用β受体阻滞剂和ACEI药物是其保护因素,能减少主动脉夹层患者的院内死亡率。结论入院时低血压、脉搏快、心包积液、白细胞计数和中性粒细胞比值增高是主动脉夹层院内死亡的独立危险因素,入院后使用β受体阻滞剂和ACEI药物是主动脉夹层的保护因素。

Objective To retrospectively analyze the related risk factors of death in the patients with aortic dissection （AD） in hospital during 2004-2014 and investigate the optimal treatment time and treatment methods in order to provide a basis for clinical practice. Methods Clinical data of 1 037 consecutive AD patients admitted in Tongji Hospital of Wuhan City from January 2004 to January 2014 were collected and retrospectively analyzed. The patients were assigned into the survival and death groups. Their general and clinical data and risk factors for death were compared. Results Among the 1 037 patients, 107 of them （10.32%） were dead during hospitalization, （53.23 ± 10.37） years. And the 930 survival cases （89.68%） were at age of （53.59± 11.81） years. For the patients in the death group, the time from admission to death was （4.17±1.65） d. Logistic regression analysis revealed that hypotension at admission （P=-0.047, OR=1.378,95% CI： 0.654-2.171 ）, fast pulse （P=0.031, OR=1.321, 95% CI：1.003- 1.039） , pericardial effusion （P=-0.016, OR=2.031, 95% CI 1.147- 3.619） , increased white blood cell count （P=0.018, OR= 1.281,95% CI ： 1.013-1.162） and neutrophil percentage （P=0.011, OR= 1.269, 95% CI： 1.028-1.119）were independent risk factors for hospital death. Beta-blockers and angiotensin-converting enzyme inhibitors after admission were protective factors, and reduced the hospital mortality for AD patients. Conclusion Hypotension, fast pulse, perieardial effusion, increased white blood cell count and neutrophil percentage are independent risk factors for hospital death, while beta-blockers and ACEI are protective factors in the AD patients.