主动脉夹层临床发病特征及重要脏器、血管受累分析

Clinical characteristics of aortic dissection and analysis of vital organs and vascular involvement

目的探讨主动脉夹层(AD)患者临床发病特征,分析重要脏器及血管受累情况以及患者预后(死亡)情况。方法连续收集1 220例急性AD患者资料,对其临床发病特征、重要脏器及血管受累情况、预后(死亡)情况进行分析。结果 1 220例AD中,DeBakeyⅢ型占42.70%(521/1 220),其次为Ⅰ型(473/1 220,38.77%)和Ⅱ型(117/1 220,9.59%)。颈部血管受累以DeBakeyⅠ型累及无名动脉最常见(183/271,67.53%);腹部血管和髂血管最高累及率分别为51.64%(221/428)和31.92%(151/473);心脏改变主要累及左心。术前凝血功能异常者占96.62%(1 003/1 038),术后肾功能异常者占57.14%(324/567)。1 220例AD患者总死亡率为14.01%(171/1 220),术前死亡原因主要为夹层破裂(81/171,47.37%),术后死亡原因主要为多器官功能衰竭和心力衰竭心律失常(66/171,38.60%)。结论 AD临床特征明显,多脏器功能衰竭是患者术后死亡的主要原因之一,临床诊治需综合考虑重要脏器受累对预后的影响。

Objective To observe the clinical characteristics of aortic dissection(AD),and to analyze the involvement status of important organs and blood vessels,as well as the prognosis(death)of AD patients.Methods Data of 1 220 acute AD patients were collected.The clinical characteristics,the involvement status of important organs and blood vessels,and prognosis(death)were analyzed.Results In all 1 220 patients,DeBakey typeⅢdissection was accounted for 42.70%(521/1 220),followed by typeⅠ(473/1 220,38.77%)and typeⅡ(117/1 220,9.59%).For the carotid arteries,the innominate artery was most involved by DeBakey typeⅠdissection(183/271,67.53%).The largest involvement rate of abdominal blood vessels and iliac blood vessels was 51.64%(221/428)and 31.92%(151/473),respectively.Cardiac changes of acute AD patients were mainly observed in left ventricle.Preoperative coagulation abnormalities accounted for 96.62%(1 003/1 038),and postoperative renal abnormalities accounted for 57.14%(324/567).The overall mortality of AD patients was 14.01%(171/1 220).The main cause of preoperative death in AD patients was aortic dissection(81/171,47.37%),of postoperative death was multiple organs failure(MOF)and cardiac arrhythmia(66/171,38.60%).Conclusion AD patients presente with special features.MOF is one of the main postoperative causes of death.The vital organs involvement in AD patients should be considered as important issue for clinical therapy and prognosis.