急性主动脉夹层患者临床特征及住院期间死亡因素分析

Clinical features and in-hospital mortality in patients with acute aortic dissection

目的:探讨急性主动脉夹层(AAD)的临床特征及住院期间影响预后的相关因素。方法:收集中日友好医院2010年10月~2016年6月于急诊科和血管外科诊治的186例AAD患者的临床资料,分为存活组和住院期间死亡组,比较2组患者的临床特征,分析AAD患者住院期间死亡的影响因素。结果:住院期间死亡组Stanford A型AAD占比、累及分支血管率均显著高于存活组(79.19%vs 44.85%,71.43%vs 28.48%,均P<0.01),心包积液/填塞发生率、急性心肌梗死发生率均高于存活组(23.81%vs 6.67%,19.05%vs 5.45%,均P<0.05);发病至就诊时间,住院期间死亡患者组用时更短(P<0.05);乳酸脱氢酶升高在住院期间死亡组中更为常见(P<0.05);存活组接受手术治疗比例更高(P<0.05)。多因素Cox回归分析显示,累及分支血管可导致AAD患者住院期间的死亡风险增加近4倍(RR=3.939,95%CI 1.492~10.399),而手术干预使AAD患者死亡风险降低76.10%(RR=0.239,95%CI 0.077~0.740)。结论 :Stanford分型、发病至就诊时间、累及分支血管及手术治疗是AAD预后的相关因素,其中累及分支血管和手术干预是影响预后的独立危险因素。

Objective：To investigate the clinical features and in-hospital prognosis of acute aortic dissection （AAD）.Methods：Retrospeetive analyses were conducted on clinical data of 186 patients with AAD in China- Japan Friendship Hospital.The cases were divided into survival group and hospitalization death group.Clinical characteristics were compared between two groups.Prognostic factors of AAD were examined in univariate and multivariate Cox models.Results：Hospitalization death group in Stanford A type AAD share, involving branch vessels rate were significantly higher than those of survival group （79.19% vs 44.85%,71.43 % vs 28.48%, both P〈O.01）.Perieardial effusion/tamponade incidence,incidence of acute myocardial infarction were higher than survival group（23.81% vs 6.67%, 19.05% vs 5.45%,both P〈O.OS）.In terms of intervals from symptom on- set to hospital,time was shorter in hospitalization death group,LDH increased more common in hospitalization death group （P〈0.05）;surgical treatment rate was higher in those of survival group （52.12% vs 23.81%,P〈 0.05）.Muhivariate Cox regression analysis showed that involving branch vessels can lead to the risk of in- hospital death of AAD increased nearly four-fold（RR=3.939,95% CI 1.492~10.399）,while surgical intervention can reduce risk of death in patients with AAD of 76.10%（RR=0.239,95% CI 0.077~0.740）.Conclusion：The prognosis of AAD was significantly associated with Stanford types,intervals from symptom onset to hospital, involving branch vessels and surgical treatment.Involving branch vessels and surgical treatment predicted inde- pendently the prognosis of AAD.