264例急性主动脉综合征临床分析

Clinical analysis of 264 cases of acute aortic syndrome

目的探讨急性主动脉综合征(acute aortic syndrome,AAS)患者的临床特征及预后情况。方法收集我院2017年1月~2019年5月急诊抢救室收治的AAS患者的基本资料、临床资料,分析其临床特征及预后情况。结果264例AAS患者的平均年龄(58.3±13.6)岁,男女比例3.55∶1,女性的发病年龄明显高于男性(P<0.05)。本组患者中,A型AAD 118例(44.69%),B型AAD 68例(25.76%),IMH 61例(23.11%),PUA 14例(5.30%),IMH并PUA3例(1.14%)。本组中76.14%的患者出现胸痛症状,63.64%的患者出现胸背痛症状,32.20%的患者出现腹痛症状,少部分患者单独或伴有晕厥、下肢疼痛麻木、呕吐等症状。A型AAD患者D-二聚体、Tn T水平均高于B型AAD患者、IMH和PUA患者,差异具有统计学意义(P<0.05);B型AAD患者D-二聚体水平与IMH和PUA患者比较,无显著差异(P>0.05);B型AAD患者Tn T水平低于IMH和PUA患者,差异具有统计学意义(P<0.05)。所有患者均经CT、MRI、CTA检测确诊。所有患者共38例在院内死亡,死亡患者Tn T、D-二聚体水平明显高于存活的患者,且收缩压更低,差异均具有统计学意义(P<0.05)。结论男性AAS患者明显多于女性,且发病年龄较女性小;疼痛是AAS的特征性临床表现;检测D-二聚体及Tn T水平有助于对AAS进行分型,但AAS确诊仍需采用CT、MRI、CTA等影像学方法检测;AAS死亡患者主要表现为Tn T、D-二聚体水平明显增高,而收缩压降低,医生应重点关注此类表现患者。

Objective To investigate the clinical characteristics and prognosis of patients with acute aortic syndrome(AAS). Methods The basic data and clinical data of AAS patients admitted to the emergency rescue room from January2017 to May 2019 in our hospital were collected. The clinical characteristics and prognosis were analyzed. Results The mean age of 264 patients with AAS was(58.3±13.6) years old, and the male to female ratio was 3.55:1. The age of onset was significantly higher in women than in men(P<0.05). In this group of patients, there were 118 cases of type A AAD(44.69%), 68 cases of type A AAD(25.76%), 61 cases of IMH(23.11%), 14 cases of PUA(5.30%), and 3 cases of IMH combined with PUA(1.14%). In the group, 76.14% of patients had symptoms of chest pain, 63.64% had symptoms of chest and back pain, 32.20% had symptoms of abdominal pain. And a small number of patients had symptoms of syncope,numbness of lower limbs, vomiting, etc. The D-dimer and Tn T levels in patients with type A AAD were higher than those in patients with type B AAD, IMH and PUA, and the difference was statistically significant(P<0.05). There was no significant difference in D-dimer between patients with type B AAD and IMH, PUA patients(P>0.05). The Tn T level of patients with B-type AAD was lower than that of IMH, PUA patients. The difference was statistically significant(P<0.05). All patients were diagnosed by CT, MRI and CTA. A total of 38 patients died in the hospital. The Tn T and Ddimer levels in the death patients were significantly higher than those in the surviving patients, and the systolic blood pressure in the death patients was lower. The differences in the data were statistically significant(P<0.05). Conclusion Male AAS patients are significantly more than females, and the age of onset in male AAS patients is smaller than that of females. Pain is a characteristic clinical manifestation of AAS. Detection of D-dimer and Tn T levels can help to classify AAS, but the diagnosis of AAS still needs the detection by CT, MRI and CTA. AAS death patients mainly show a significant increase in Tn T, D-dimer levels, and decreased systolic blood pressure. Doctors should focus on such performance patients.