急性主动脉夹层198例患者临床特征及两型比较

Clinical features in 198 patients with acute aortic dissection and the comparisons between the two types

目的分析急性主动脉夹层(acute aortic dissection,AAD)患者的危险因素、临床表现、并发症、诊断、治疗及结局。方法回顾性分析198例AAD患者的临床资料,并比较A型AAD(type A AAD,A-AAD)和B型AAD(type B AAD,B-AAD)患者的临床特征。结果 AAD患者男女比例为3.5∶1。71.7%的AAD患者既往有高血压病史。81.3%的AAD患者发病时会出现胸痛。A-AAD患者并发急性心肌梗死的比例显著高于B-AAD患者(35%vs.12%,P<0.01)。经胸心脏超声对A-AAD的筛检价值要高于B-AAD(36%vs.8%,P<0.01)。A-AAD患者的院内总病死率显著高于B-AAD患者(20%vs.1%,P<0.01)。结论 AAD患者男性明显多于女性,发病年龄呈正态分布。高血压病是其最常见的危险因素。AAD临床表现复杂多样,以胸痛最为常见。A-AAD患者更易并发急性心肌梗死。经胸心脏超声可作为A-AAD急诊筛查的首选方法。A-AAD和B-AAD患者的治疗和结局有所差异。

AIM To investigate risk factors, clinical manifestations, complications, diagnosis, treatments and outcomes in patients with acute aortic dissection （AAD）. spectively analyzed clinical materials of 198 patients with METHODS The present investigation retro- AAD and clinical features between patients with type A AAD （A-AAD） and type B AAD （B-AAD） were compared. RESULTS The male-to-female ratio was 3.5 ： 1 in patients with AAD. 71.7% of patients with AAD had a history of hypertension. Chest pain existed in 81.3% of patients with AAD. The proportion of patients with A-AAD who had concomitant acute myocardial infarction was significantly higher than patients with B-AAD （35% vs. 12 %, P 〈0. 01 ）. The transthoracic echocardiography had greater value in the detection of A-AAD than B-AAD （36% vs. 8%, P 〈0. 01 ）. The overall in-hospital mortality of patients with A-AAD was significantly increased when compared with patients with B-AAD （20% vs. 1%, P 〈 0. 01 ）. CONCLUSION Males had greater prevalence of AAD and ages showed normal distribution. Hypertension was the most common risk factor of AAD. Although clinical manifestations of AAD were complicated, chest pain was the most common symptom. Patients with A-AAD were more likely to have concomitant acute myocardial infarction. The transthoracic echocardiography could be were discrepancies among treatments and regarded as the prior method for the detection of A-AAD. There outcomes between patients with A-AAD and patients with B-AAD.