影响复杂性StanfordB型主动脉夹层院内死亡的危险因素分析

Risk Factors for Hospital Mortality in Patients with Complicated Acute Type B Aortic Dissection

目的:探讨复杂性Stanford B型主动脉夹层患者院内死亡的危险因素。方法:回顾性分析2010年1月至2015年6月急诊收治入院的98例复杂性Stanford B型主动脉夹层患者的住院病例资料,对可能影响复杂Stanford B型主动脉夹层院内死亡的15项临床病理因素:患者年龄、性别、治疗方式、发病至就诊时间、既往是否有高血压病史、就诊时收缩压、入院时是否合并肺部感染、慢性肾功能不全、既往结缔组织病、主动脉扩张、急性肾损伤、心包积液、胸腔积液、腹腔积液、心肌灌注、肠系膜动脉灌注、下肢灌注,进行单因素和多因素回归分析。结果:单因素分析结果显示:患者年龄、就诊时收缩压、治疗方式、急性肾损伤、心肌灌注不良、心包积液、主动脉扩张、下肢灌注不良与院内死亡有关(P<0.1)。经COX多因素回归分析结果显示:TEVAR治疗(HR=8.437CI 1.048-67.925 P=0.045),心包积液(HR=4.010 CI 1.675-9.598 P=0.002),下肢灌注不良(HR=3.133 CI 1.083-9.064 P=0.035)与院内死亡有关(P<0.05)。结论:心包积液及下肢灌注不良可使复杂性Stanford B型主动脉夹层患者院内死亡率增加,而TEVAR可有效改善患者早期预后。

Objective： To investigate the risk factors for hospital mortality in patients with complicated acute type B aortic dissection. Methods： 98 patients with complicated acute type B aortic dissection from 2010 to 2015 were analyzed. COX regression analysis of 15 clinical pathological factors that may affect the hospital mortality of complicated B type Stanford aortic dissection. Results： Univariate analysis revealed that age,systolic blood pressure, treatment modality, acute kidney injury, myocardial perfusion, perieardial effusion, aortic dilatation and lower limb perfusion were associated with death in hospital （P〈0.1）. Multivariate COX regression analysis revealed that TEVAR （HR=8.437 CI 1.048~67.925 P=0.045）, pericardial effusion （HR=4.010 CI 1.675-9.598 P=-0.002）, lower limb perfusion （HR=3.133 CI 1.083-9.064 P=-0.035） were associated with hospital mortality. Conclusion： Subdivision of the disease is helpful to individual treatment plan. In this study, we found that the hospital mortality was increased in patients with complicated acute type B aortic dissection associated with pericardial effusion and lower limb perfusion. TEVAR could effectively improve the prognosis of patients with early stage, because there are few cases of traditional open surgery in this study, the benefit of the two groups could not be compared effectively.