年龄对于复杂性急性Stanford B型主动脉夹层患者预后的影响

Effect of Age on the Prognosis of Complicated Acute Type B Aortic Dissection

目的:探讨年龄对于复杂性急性Stanford B型主动脉夹层(Complicated acute type B aortic dissection,cABAD)患者预后的影响。方法:回顾性分析2010年1月至2017年6月急诊收治入院的156例cABAD患者的住院病例资料,将其根据不同的年龄、治疗方式(药物保守治疗、血管内介入治疗、传统手术治疗)及治疗结果进行分组,并在不同的年龄组进行分析。结果:本研究的患者平均年龄为52.46±11.72岁,45%的患者(n=70)大于65岁,55%的患者(n=86)小于65岁。小于65岁的患者有22.2%的患者(n=19)接受药物保守治疗、19.8%的患者(n=17)接受传统手术治疗、58%的患者(n=50)接受血管内介入治疗,大于65岁的患者有48.6%的患者(n=34)接受药物保守治疗、11.4%的患者(n=8)接受传统手术治疗、40%的患者(n=28)接受血管内介入治疗。小于65岁与大于65岁患者院内死亡率分别为12.8%与35.7%(P<0.001),接受血管内治疗分别为2%与28.6%(P=0.001),常规手术治疗分别为21%与37.5%(P=0.468),药物保守治疗分别为31.5%与41.7%(P=0.489)。年龄65岁或以上是多因素分析中住院死亡率的预测因子(OR=2.72;95%CI 1.343-4.674; P=0.012)。结论:年龄≥65岁对于cABAD患者的预后具有显著的影响,血管内介入治疗可有效降低院内死亡率,但死亡率随着年龄的增长而升高。

Objective: To investigate the impact of age on the prognosis of patients with complex acute Stanford B aortic dissection(Complicated acute type B aortic dissection, cABAD). Methods: The outcomes of 156 cases of patients with cABAD in our hospital from 2010 to 2017 were analyzed. All the cABAD patients were categorized according to age, treatment(drug treatment,endovascular treatment, traditional surgical treatment) and the outcomes were analyzed in different age groups. Results: The mean age of cohort was 52.46±11.72 years, 45% of patients(n=70) were greater than 65 years of age and 55%(n =86) were less than 65 years. Less than 65 years of age, 22.2% of patients(n=19) received drug treatment, 19.8% of patients(n=17) received traditional surgical treatment,and 58% of patients(n=50) received endovascular treatment, more than 65 years of age 48.6% of patients(n=34) received drug treatment,11.4% of patients(n=8) received traditional surgical treatment, and 40% of patients(n=28) received endovascular treatment. The in-hospital mortality rate of less than 65 years old and older than 65 years were 12.8% and 35.7%(P<0.001), received endovascular treatment were 2% and 28.6%(P=0.001) and conventional surgical treatment were 21% and 37.5%(P=0.468) and drug treatment were31.5% and 41.7%(P=0.489). Age 65 years or greater was a predictor ofin-hospital mortality in multivariate analysis(OR = 2.72;95%CI1.343-4.674;P = 0.012). Conclusion: Age≥65 years old has significant effect on the prognosis of patients with cABAD, endovascular treatment can effectively reduce the in-hospital mortality, but the mortality rate increased with age.