不同Stanford分型急性主动脉夹层患者临床特征的对比分析

Clinical Features in Acute Aortic Dissection Patients with Different Stanford Types:a Contrastive Analysis

目的对比不同Stanford分型急性主动脉夹层(AAD)患者的临床特征,为临床有效诊治AAD提供参考。方法选取2016-2018年河南宏力医院急诊科收治的AAD患者33例,其中Stanford分型A型19例,B型14例。对比不同Stanford分型AAD患者一般资料、临床症状、临床体征、辅助检查结果及住院期间死亡情况。结果(1)不同Stanford分型AAD患者性别,年龄,发病至就诊时间,有高血压、肾衰竭并肾性高血压、马凡综合征、脑梗死、结肠癌病史及无明确病史者所占比例比较,差异无统计学意义(P>0.05)。(2)不同Stanford分型AAD患者胸痛、背痛、腹痛、胸背疼痛、胸腹疼痛、复杂疼痛、迁延疼痛、昏迷、烦躁、胸闷发生率比较,差异无统计学意义(P>0.05)。(3)不同Stanford分型AAD患者心率及休克、血压不对称、足背动脉不对称发生率比较,差异无统计学意义(P>0.05),而Stanford B型AAD患者双侧上肢收缩压、舒张压高于Stanford A型患者(P<0.05)。(4)Stanford A型AAD患者主动脉反流、心包积液、颈动脉和/或头臂干受累发生率高于Stanford B型患者(P<0.05),而不同Stanford分型AAD患者胸腔积液、腹腔干和/或肠系膜动脉受累、肾动脉受累发生率比较,差异无统计学意义(P>0.05)。(5)住院期间Stanford A型AAD患者病死率高于Stanford B型患者(P<0.05)。结论不同Stanford分型AAD患者双侧上肢血压、主动脉反流、心包积液、颈动脉和/或头臂干受累及住院期间死亡情况存在一定差异,因此临床医生应积极掌握不同Stanford分型AAD患者的临床特征,以提高AAD的早期诊断、治疗率,降低AAD病死率。

Objective To contrastively compare the clinical features in acute aortic dissection(AAD)patients with different Stanford types,to provide a reference for effective clinical diagnosis and treatment of AAD.Methods From 2016 to 2018,a total of 33 patients with AAD were selected in the Department of Emergency Medicine,Henan Hongli Hospital,including 19 cases with Stanford A type and 14 cases with Stanford B type.General information,clinical symptoms and signs,adjuvant examination results and death during hospitalization were compared in AAD patients with different Stanford types.Results(1)No statistically significant difference of gender,age,duration between attack and seeing a doctor,proportion of patients with history of hypertension,renal failure complicated with renal hypertension,Marfan’s syndrome,cerebral infarction or colorectal carcinoma,or without clear medical history was found in AAD patients with different Stanford types(P>0.05).(2)No statistically significant difference of incidence of chest pain,backache,abdominal pain,thoracic vertebral pain,chest and abdominal pain,complex pain,wandering pain,coma,dysphoria or chest distress was found in AAD patients with different Stanford types(P>0.05).(3)No statistically significant difference of heart rate,incidence of shock,asymmetric blood pressure or asymmetry of dorsal foot artery was found in AAD patients with different Stanford types(P>0.05),while SBP and DBP of bilateral upper limbs in AAD patients with Stanford B type were statistically significantly higher than those in AAD patients with Stanford A type(P<0.05).(4)Incidence of aortic reflux,hydropericardium,carotid artery and/or truncus brachiocephalicus involvement in AAD patients with Stanford A type was statistically significantly higher than that in AAD patients with Stanford B type,respectively(P<0.05),while no statistically significant difference of incidence of pleural effusion,coeliac trunk and/or mesenteric artery involvement or renal artery involvement was found in AAD patients with different Stanford types(P>0.05).(5)Fatality rate in AAD patients with Stanford A type was statistically significantly higher than that in AAD patients with Stanford B type during hospitalization(P<0.05).Conclusion There is significant difference in blood pressure of bilateral upper limbs,incidence of aortic reflux,hydropericardium,carotid artery and/or truncus brachiocephalicus involvement,and death during hospitalization to some extent in AAD patients with different Stanford types,thus clinicians should actively know well of the clinical features in AAD patients with different Stanford types,to improve the early diagnosis rate and treatment rate,reduce the lethality rate.