老年Stanford B型主动脉夹层的临床特点及治疗方案选择

Clinical features and treatment options of Stanford type B aortic dissection in the elderly

目的总结老年Stanford B型主动脉夹层(AD)的临床特点并探讨治疗方案的选择。方法回顾性分析2012年7月至2016年7月55例老年B型AD患者的临床资料,其中单纯B型AD患者19例接受单纯药物治疗(药物治疗组),复杂B型AD患者36例在进行药物治疗的同时行腔内手术治疗(腔内治疗组)。收集患者年龄、性别、发病季节、诊断时长、临床表现、高血压分级、影像学表现等,分析两组患者不同治疗方案的预后情况。根据数据类型,两组比较采用t检验、卡方检验或秩和检验。结果 55例患者春、冬季发病居多,共41例(74.5%);药物治疗组年龄与腔内治疗组比较,差异有统计学意义[(70.68±6.84)vs(66.75±5.33)岁;P=0.022],两组性别、诊断时长、临床表现、高血压分级、影像学表现等指标相比较,差异无统计学意义(P>0.05);平均随访时间11.2个月,53例(96.4%,53/55)获随访,2例失访;药物治疗组症状缓解率显著低于腔内治疗组,差异有统计学意义(68.4%vs 94.4%;P<0.05),两组各并发症发生率及死亡率比较,差异无统计学意义(P>0.05);药物治疗组3例患者出院后1~3个月因胸背部疼痛不缓解或复查CTA提示夹层进行性增大而接受腔内治疗,再次手术干预率略大于腔内治疗组,但差异无统计学意义(P>0.05)。结论老年B型主动脉发病季节集中,症状多样且不典型,临床中应提高关注;对于老年夹层患者,腔内治疗仍是主要治疗手段。

Objective To summarize the clinical characteristics and treatment options of Stanford type B aortic dissection（AD） in the elderly patients. Methods The clinical data of 55 elderly patients diagnosed with Stanford type B AD in our department from July 2012 to July 2016 were collected. The 19 patients （medication group） with simple Stanford type B aortic dissection were treated with medication, and the other 36 patients （endovascular treatment group） with complicated type were given endovascular surgery plus medication. A statistical analysis was conducted on their age, gender, on-set season, diagnostic duration, clinical manifestations, hypertension grades, and imaging findings. The prognoses of patients with different treatment options were analyzed. SPSS statistics 21.0 was employed for data analysis. And Student＇s t test,Chi-square test or rank sum test was employed for comparison for different data between the 2 groups. Results Among the 55 patients, the most common on-set season was spring and winter, accounting for 74.6%（41 patients）. There was a significant difference in the age between the medication and endovascular treatment groups [（70.68±6.84） vs （66.75±5.33）years, P=0.022]. But no differences were seen in the gender, diagnostic duration, clinical manifestations,hypertension grades,and imaging findings between the 2 groups （P〉0.05）. Fifty-three patients （96.4%,53/55） were followed up for a mean period of 11.2 months,and 2 patients were lost. The rate of symptom relief was significantly lower in the medication group than the endovascular treatment group（68.4% vs 94.4%,P〈0.05）. No differences were seen in the incidence of complications and mortality rate between the 2 groups （P〉0.05）. In the medication group, 3 patients were re-hospitalized due to chest pain in 1 to 3 months after discharge,and CT angiography indicated the progressive increase of the dissection,so endovascular surgery was carried out. The re-operation rate was slightly greater in the medication group than the endovascular treatment group, though without obvious difference （P〉0.05）. Conclusion For the elderly patients, Stanford type B AD is common in spring and winter,and with varied and atypical symptoms. So, great attention should be paid to the disease. Endovascular treatment is still its main treatment.