桂西地区主动脉夹层诊治10年变迁

Changes of diagnosis and treatment for aortic dissection during past ten years in western Guangxi

目的探讨10年来桂西地区主动脉夹层(aortic dissection,AD)诊治变化,总结诊治经验,以期提高本地区对AD的认识。方法将右江民族医学院附属医院收治的72例AD分为两组,2007年1月1日—2011年12月31日病例为第1组(n=13),2012年1月1日—2016年12月31日病例为第2组(n=59)。分析两组AD患者一般资料、发病危险因素及治疗手段变化与疾病转归。结果所有经CTA、DSA或UCG确诊的病例72例,男性58例(80.55%),女性14例(19.45%),男女之比4.14∶1,平均年龄(55.00±15.13)岁。高血压(83.33%)、长期大量吸烟史(48.61%)是AD主要高危因素,第1组与第2组基础病与危险因素对比差异无统计学意义(P>0.05)。2007~2016年间AD病例数有显著上升的趋势:第1组13例,第2组59例,在2个五年周期中增加了46例,增长了354.00%。三种治疗方案[内科保守治疗、胸主动脉腔内修复术(throacic endovascular aortic repair,TEVAR)、外科杂交手术]使用率第1组(84.62%,7.69%,7.69%)与第2组(62.71%,35.59%,1.69%)分别对比发生了较大变化,TEVAR术使用率较前明显增长,但差异无统计学意义(P>0.05)。第1组和第2组的治疗有效率分别是53.85%、93.75%,院内死亡率分别是46.15%、6.25%,两组治疗有效率、死亡率比较差异有统计学意义(P<0.05)。结论 10年来桂西地区AD的住院患者在急剧增加,高血压、男性、长期大量吸烟史是桂西地区AD主要高危因素。TEVAR术的应用在桂西地区逐渐增加,AD的治疗有效率大幅度提升,住院病死率明显下降。

Objective To investigate the changes of diagnosis and treatment for aortic dissection（AD）during the past ten years in western Guangxi and to summarize experiences in the diagnosis and treatment ofAD so as to improve people＇s awareness of AD. Methods Seventy-two patients with AD cared at Affiliated Hospital of Youjiang Medical University for Nationalities were selected in this study and were randomly divided into two groups：Group 1（cases treated between January 1,2007 and December 31,2011,n =13）and Group2（cases treated between January 1,2012 and December 31,2016,n =59）.A retrospective analysis of baseline data of patients with AD,risk factors,treatment technique changes and disease outcome was performed for 72 AD cases in the two groups. Results All 72 patients with AD were diagnostically confirmed by CTA、DSA or UCG.There were 58 males（80.55%）and 14 females（19.45%）,the ratio of male to female was 4.14︰1 and the average age was（55.00 ± 15.13）years old.Hypertension（83.33%）and long-term heavy smoking history（48.61%）were the main risk factors of AD.Comparison of the basic diseases and risk factors of Group1 with those of group 2 showed that there were no statistically significant differences（P〈0.05）.There was a significant increase in the number of AD cases between 2007 and 2016.There were 46 more cases in latter five-year period,and the total number of cases increased by 354.00%.For three kinds of treatment[conventional medical treatment,thoracic endovascular aortic repair（TEVAR）and surgical hybridization],there was a significant change in the usage rate between Group 1（84.62%,7.69%,7.69%）and Group 2（62.71%,35.59%,1.69%）.Compared with Group 1,the usage rate of TEVAR in Group 2 was significantly increased but the difference was not statistically significant（P〈0.05）.The effective rates in group1 and group2 were respectively 53.85%and 93.75%.The in-hospital mortality rates were 46.15%and 6.25%,respectively.There were statistically significant differences between the two groups in the treatment effectiveness and mortality（P〈0.05）. Conclusion The number of in-patients with AD in western Guangxi has a sharp increase over the past 10 years.Hypertension,male,long-term heavy smoking history are major risk factors of AD in western Guangxi.The application of TEVAR is gradually increasing in western Guangxi.The therapeutic effectiveness of AD is increased significantly and the in-hospital mortality is decreased significantly.