老年Stanford A型主动脉夹层患者的临床特点及院内不良事件分析

Analysis of clinical characteristics and inpatient adverse events of elderly patients with Stanford A type of aortic dissection

目的观察老年StanfordA型主动脉夹层患者的临床特点及院内不良事件的发生情况.方法采用回顾性研究方法,选取2013年1月至2015年12月在首都医科大学附属北京安贞医院确诊为StanfordA型主动脉夹层的患者588例,按患者年龄分为老年组(年龄≥60岁,79例)和非老年组(<60岁,509例).比较两组患者的一般临床资料、住院相关检查结果、治疗用药、手术干预及院内不良事件的差异.结果与非老年组比较,老年组患者男性比例、年龄、身高、体质量指数(BMI)、嗜酒史比例、血红蛋白(Hb)、院内急性肝衰竭发生率均明显降低〔男性比例:60.8%(48/79)比80.6%(410/509),年龄(岁):64.81±4.66比45.05±8.63,身高(cm):169.41±8.09比173.39±7.59,BMI(kg/m2):24.24±2.93比25.50±3.82,嗜酒史比例:12.7%(10/79)比22.4%(114/509),Hb(g/L):122.62±21.14比128.42±23.44,院内急性肝衰竭发生率:0(0/79)比5.3%(21/509),均P<0.05〕,糖尿病史比例、脑血管病史比例、院内全因病死率均明显升高〔糖尿病史比例:24.1%(62/79)比8.8%(45/509),脑血管病史比例:6.3%(5/79)比2.2%(11/509),院内全因病死率:16.5%(13/79)比7.1%(36/509),均P<0.05〕,左心室舒张期末内径(LVEDD)明显缩小(mm:48.38±6.11比50.77±7.56,P<0.05).结论老年StanfordA型主动脉夹层患者合并症多、院内病死率高,应重点防范院内不良事件发生.

Objective To illustrate the clinical characteristics of elderly patients with Stanford type A aortic dissection and to discuss the incidence of such inpatients*adverse events.Methods A retrospective study was conducted,588 patients with definite diagnosis of Stanford type A aortic dissection admitted to Beijing Anzhen Hospital of Capital Medical University from January 2013 to December 2015 were enrolled,and they were divided into an elderly group(≥60 years,79 cases)and a non-elderly group(<60 years,509 cases).The differences of general clinical data,results of hospitalization-related examinations,medication for treatment,surgical intervention and inpatient adverse events between the two groups were compared.Results Compared with non-elderly group,the proportion of male,age,stature,body mass index(BMI),proportion of alcohol history,hemoglobin(Hb),incidenee of acute liver failure in hospital in elderly group were decreased significantly[proportion of male:60.8%(48/79)vs.80.6%(410/504),age(years):64.81±4.66 vs.45.05±8.63,stature(cm):169.41±8.09 vs.173.39±7.59,BMI(kg/m^2):24.24±2.93 vs.25.50±3.82.proportion of alcohol history:12.7%(10/79)vs.22.4%(114/509).Hb(g/L):122.62±21.14 vs.128.42±23.44,incidence of acute liver failure:0(0/79)vs.5.3%(21/509),all P<0.05],the proportion of diabetes history,proportion of cerebrovascular diseases,all-cause mortality in this hospital in elderly group were in creased significantly[proportion of diabetes history:24.1%(62/79)vs.8.8%(45/509),proportion of cerebrovascular diseases:6.3%(5/79)vs.2.2%(11/509),all-cause mortality:16.5%(13/79)vs.7.1%(36/509),all P<0.05],and the left ventricular end diastolic internal diameter(LVEDD)in elderly group decreased significantly(mm:48.38±6.11 vs.50.77±7.56.P<0.05).Conclusion The elderly patients with Stanford type A aortic dissection suffer from more complications and higher mortality,therefore,the risk consciousness should be strengthened for the senile patients and more attention should be paid on the prevention of the elderly inpatients'adverse events.