胸主动脉腔内修复术后持续疼痛对B型主动脉夹层预后的影响

The eff ect of persistent pain after thoracic endovascular aortic repair on prognosis of type B aortic dissection

目的探讨胸主动脉腔内修复术(TEVAR)后持续疼痛对B型主动脉夹层患者中长期预后的影响。方法回顾性分析2012年1月至2016年12月解放军总医院第六医学中心连续收治并进行TEVAR的B型主动脉夹层患者的临床资料32例,并进行随访。按照术后是否出现疼痛分为疼痛组和非疼痛组。结果30例患者完成了平均5.25年随访,疼痛组13例,非疼痛组17例。两组患者的性别、年龄、合并疾病、住院天数、住院费用及发病至手术间隔时间比较,差异均无统计学意义(均P>0.05)。疼痛组手术所用时间短于非疼痛组[(83.46±10.37)min比(92.59±9.36)min,P=0.017],支架平均直径大于非疼痛组[(37.62±3.93)mm比(33.35±2.50)mm,P=0.001],差异均有统计学意义。疼痛组患者支架平均长度虽较非疼痛组偏长,但差异无统计学意义[(183.38±31.25)mm比(172.00±28.10)mm,P=0.304]。疼痛组死亡1例,再发夹层1例;非疼痛组死亡2例,再发夹层1例,再次介入治疗1例。疼痛组与非疼痛组患者复合终点事件发生率比较,差异无统计学意义[2(2/13)比4(4/17),P=0.655]。结论尚无法得出TEVAR术后持续疼痛对B型主动脉夹层长期预后是否产生不利影响。

Objective To investigate the effect of persistent pain after thoracic endovascular aortic repair(TEVAR)on prognosis of type B aortic dissection.Methods A retrospective analysis of consecutive admission of 32 patients between January 2012 to December 2016 underwent TEVAR for type B aortic dissection was conducted.The patients were divided into persistent pain group and non-pain group according to whether there was pain after TEVAR or not.Results A total of 30 patients received TEVAR and were successfully followed up,the mean time of follow up was 5.25 years.There were 13 patients in the pain group and 17 patients in the non-pain group.There were no signifi cant diff erences between the two groups in age,gender,comorbidities,the length of hospital stay,total cost or time duration from onset to procedure(all P>0.05).The time of procedure in the pain group was shorter than that in the control group[(83.46±10.37)min vs.(92.59±9.36)min,P=0.017].The mean diameter of stent was larger than that of the control group[(37.62±3.93)mm vs.(33.35±2.50)mm,P=0.001].Although the average length of stent in pain group was longer than that in non-pain group,the diff erence was not statistically signifi cant[(183.38±31.25)mm vs.(172.00±28.10)mm,P=0.304].In the pain group,1 case died,and 1 case occurred re-dissection.In the non-pain group,2 cases died,1 case occurred re-dissection and 1 case received a second intervention.There was no signifi cant diff erence in the incidence of composite end points between the two groups[2(2/13)vs.4(4/17),P=0.655].Conclusions This study did not show that persistent pain after TEVAR had adverse eff ect on the long-term prognosis of type B aortic dissection.