床旁超声心动图在Stanford A型主动脉夹层诊断和院内死亡风险评估中的价值

Value of bedside ultrasound cardiogram in the diagnosis and risk assessment of in-hospital death of Stanford A type aortic dissection

目的 探讨床旁超声心动图(UCG)在Stanford A型主动脉夹层(AD)诊断和院内死亡风险评估中的价值。方法 回顾性选取2019年6月至2023年6月大同市第五人民医院收治的AD患者104例为研究对象,均给予床旁UCG与数字减影血管造影(DSA)检查,分析床旁UCG临床诊断Stanford A型AD的价值;根据院内存活与死亡情况将确诊为Stanford A型AD的患者分为存活组(n=52)和死亡组(n=28)。绘制受试者工作特征(ROC)曲线,评估床旁UCG的临床诊断价值。分析两组人口学资料、既往病史、疾病信息,并观察两组床旁UCG的图像表现。多因素Logistic回归分析Stanford A型AD患者院内死亡的影响因素。结果 经DSA检查,Stanford A型AD患者80例,StanfordB型AD患者24例。床旁UCG诊断Stanford A型AD患者为79例,Stanford B型AD患者为25例。床旁UCG诊断Stanford A型AD患者的敏感性为97.50%,特异性为95.83%,准确性为97.12%,曲线下面积为0.961,95%CI(0.000~1.000)(P<0.05)。存活组患者接受手术治疗、DeBakey分型(Ⅱ型)占比分别为88.46%、71.15%,均高于死亡组(25.00%、46.43%),左心室收缩功能降低(LVEF>50%)占比为0,低于死亡组(32.14%),差异均有统计学意义(P<0.05)。存活组患者主动脉受累、重度反流、心包积液及主动脉根部直径分别为15.40%、9.62%、34.62%、(41.12±5.12) mm,均低于死亡组[82.14%、78.57%、71.43%、(54.03±9.24) mm],差异均有统计学意义(P<0.05)。多因素Logistic回归分析,主动脉受累、根部直径、主动脉瓣重度反流、是否接受手术治疗情况为引发Stanford A型主动脉夹层院内死亡的独立危险因素(P<0.05)。结论 床旁UCG可作为确诊Stanford A型AD的诊断工具,且通过床旁UCG表现可对院内死亡进行风险评估,其中主动脉受累、重度返流、根部直径及是否接受手术治疗均是院内死亡的独立危险因素。

Objective To investigate the value of bedside uItrasound cardiogram(UCG) in the diagnosis and risk assessment of in-hospital death of Stanford A type aortic dissection(AD).Methods The study method were a retrospective analysis.The observation objects were 104 patients with AD admitted to The Fifth People's Hospital of Datong from June 2019 to June 2023.All patients were examined by bedside UCG and digital subtraction angiography(DSA) to analyze the clinical diagnosis value of bedside UCG in Stanford A type AD.Patients diagnosed with Stanford A type AD were divided into survival group(n=52) and death group(n=28) according to in-hospital survival and death.The clinical diagnostic value of bedside UCG were evaluated,receiver operating characteristics(ROC) curve were drawn,and the image manifestations of bedside UCG in the two groups were observed.The demographic data,past medical history,and disease information of two groups were analyzed,and the imaging manifestations of bedside UCG were observed.The relevant information were included in the multivariate regression analysis model to evaluate the influencing factors of in-hospital death in Stanford A type AD patients.Results According to DSA examination,there were 80 patients with Stanford A type AD and 24 patients with Stanford B type AD.There were 79 patients with Stanford A type AD and 25 patients with Stanford B type AD diagnosed by bedside UCG.The sensitivity,specificity,accuracy was 97.50%,95.83%,97.12%,respectively,area under curve(AUC) curve area was 0.961,95%CI(0.000-1.000)(P<0.05).The proportion of patients in the survival group who received surgical treatment and DeBakey classification(type II) were 88.46% and 71.15%,respectively,which were higher than those in the death group(25.00% and 46.43%),the proportion of patients with reduced left ventricular systolic function(EF>50%) was 0,which was lower than that in the death group(32.14%),and the differences were statistically significant(P<0.05).The aortic involvement,severe reflux,pericardial effusion,and aortic root diameter in the survival group were 15.40%,9.62%,34.62%,and(41.12±5.12) mm,respectively,which were lower than those in the death group [82.14%,78.57%,71.43%,and(54.03±9.24) mm],and the differences were statistically significant(P<0.05).Multivariate logistic regression analysis showed that aortic involvement,root diameter,aortic valve severity and surgical treatment were independent risk factors for in-hospital death of Stanford A type AD(P<0.05).Conclusion Bedside UCG can be used as diagnostic tool for the diagnosis of Stanford A type AD,and bedside UCG manifestations can be used to assess the risk of in-hospital death,among which aortic involvement,severe reflux,root diameter,and whether or not to receive surgical treatment are independent risk factors for in-hospital death.