急性主动脉夹层累及分支血管对住院期间死亡率的影响

Acute aortic dissection involving aortic branch vessels affects mortality during hospitalization

目的探讨急性主动脉夹层 （acute aortic dissection, AAD）累及主动脉分支血管（involving aortic branchvessels, IBAV）的分布情况及其对住院期间患者预后的影响。方法本研究为回顾性、单中心研究，收集2010年10月-2016年12月中日友好医院急诊科和血管外科就诊的202例AAD患者临床资料，根据是否累及主动脉分支血管分为两组：IBAV组和未累及主动脉分支血管（without involving aortic branch vessels, WIBAV）组，分析两组的临床特征、D-二聚体水平并进行比较，应用Kaplan—Meier生存方法比较两组患者的预后。结果63例（3t．19％）IBAV的AAD患者中，最常累及的主动脉分支血管为髂动脉及以远动脉（38．10％），其次为肾动脉（36．51％）和腹腔干动脉（28．57％）。IBAV组AAD患者D-二聚体水平明显高于WIBAV组患者（3103．50ng／ml vs.2338．46ng／ml，P〈0．001）；Kaplan—Meier生存分析发现，IBAV组AAD患者住院期间死亡率明显高于WIBAV组（28．57％VS．7．91％，P〈0．001）；与保守治疗相比，手术治疗明显降低了IBAV组AAD患者的死亡率（47．06％VS．6．90％，P〈0．001），但在WIBAV组患者的死亡率降低方面，差别无统计学意义（11．43％VS．4．35％，P〉0．05）。结论IBAV的AAD引起D-二聚体升高水平高于WIBAV的AAD患者，并增加患者住院期间的死亡率，手术治疗能够改善IBAV患者的预后。

Objective To investigate the acute aortic dissection （AAD） involving aortic branch vessels （IABV）on D-dimer level and mortality during hospitalization. Methods A retrospective analysis was conducted on a total of 202 cases with AAD who were admitted emergency room at China-Japan Friendship Hospital in between October 2010 and December 2016. They were divided into AAD with IABV group and AAD without IABV （WIABV） group. Clinical characteristics and D-dimer level of the two groups were compared. Death-free survival curves were calculated by the Kaplan-meier method. Results In 63 cases （31.19%） of AAD with IABV, the most frequently involved branch of aortic vascular was lliac artery and beyond （38.10%）, followed by renal artery （36.51%）, and celiac artery （28.57%）. D-dimer level in AAD with IABV group was significantly higher than that of WIABV group （3103.50 ng/ml vs. 2338.46 ng/ml, P 〈 0.001）. Kaplan-meier survival analysis found that mortality during hospitalization was significantly higher in patients of ADD with IABV group than WIABV patients （28.57% vs. 7.91%, P 〈 0.001）. Compared with conservative treatment, surgical treatment significantly reduced the mortality rate of AAD with IABV （47.06% vs. 6.90%, P 〈 0.001）. However, there was no statistically significant difference of mortality between conservative treatment and surgical treatment （11.43% vs. 4.35%, P 〉 0.05） in WIABV group. Conclusion The D-dimer level in patients of AAD with IABV was significantly higher than that in those without IABV. The mortality was increased in patients of ADDwith IABV and surgical treatment may improve the prognosis of these patients.