急性主动脉夹层患者发病特征

Pathogenesis of Patients with Acute Aortic Dissection

目的 分析急性主动脉夹层患者相关发病特征。方法 回顾性分析2021年7月至2023年6月河南省郑州市5所三级甲等医院救治的239例急性主动脉夹层患者的年龄、性别、发病时间(日间分布、季节分布)、临床首发症状、危险因素、救治与转归情况、住院手术花费、平均住院天数特点。结果 急性主动脉夹层发病男女性别比例2.85∶1,男性及女性主动脉夹层分型比较,差异无统计学意义(χ^(2)=0.895,P=0.368)。发病年龄(53.79±13.53)岁,其中男性患者发病年龄(51.64±12.91)岁与女性患者发病年龄(59.92±13.47)岁相比,差异有统计学意义(t=4.005,P<0.001)。Stanford A患者发病年龄(52.10±13.41)岁与Stanford B患者发病年龄(56.44±13.36)岁相比,差异有统计学意义(t=2.363,P=0.020)。发病有昼夜、季节交替现象,0:00—6:00发病人数相对平缓,6:00—12:00发病人数开始增加,至12:00—18:00达到峰值,18:00—24:00逐渐回落。冬、春、秋发病率偏高,夏季相对较低。239例急性主动脉夹层首发症状为胸、背或腹部疼痛患者共196例,既往有高血压病史患者189例。经手术治疗的Stanford A住院费用(24.58±0.63)万元,住院天数(17.85±10.92)d;Stanford B型患者住院费用(17.41±0.55)万元,住院天数(17.26±11.84)d。结论 急性主动脉夹层患者发病人数男性大于女性,且男性发病相对年轻,发病率有上升趋势。胸、背或腹部疼痛为多数急性主动脉夹层首发症状,高血压是其发病的独立危险因素,吸烟、饮酒、糖尿病等危险因素与急性主动脉夹层发病相关性仍有待于进一步证实。手术治疗仍是目前降低此类疾病死亡率的关键,且随着主动脉夹层诊疗技术的日益完善,其院内病死率逐渐下降。

Objective The relevant characteristics of acute aortic dissection were analyzed.Methods A retrospective analysis was performed on 239 patients with acute aortic dissection treated from July 2021 to June 2023 in 5 gradeⅢand class A hospitals in Zhengzhou City,Henan Province,including age,sex,time of onset(day distribution,season distribution),first clinical symptoms,risk factors,treatment and outcome,hospitalization operation cost,and average length of stay.Results The ratio of male to female with acute aortic dissection was 2.85∶1.There was no significant difference between men and women with aortic dissection classification(χ^(2)=0.895,P=0.368).The age of onset was(53.79±13.53)years old,while the average age of onset of male and female patients was(51.64±12.91)and(59.92±13.47)years old,respectively(t=4.005,P<0.001).The age of onset of patients with Stanford A was(52.10±13.41)years,which was statistically significant compared with that in patients with Stanford B(56.44±13.36)years(t=2.363,P=0.020).The incident was different with the alternation of day and night,seasons.The number of people suffering from the disease was relatively flat from 0:00 to 6:00,while the number starts to increase from 6:00 to 12:00 and reaches the peak from 12:00 to 18:00,then gradually drops from 18:00 to 24:00.The incidence rate was higher in winter,spring and autumn,while it was lower in summer.There was 196 patients with the chest,back or abdominal pain among the first symptom of 239 patients with acute aortic dissection,while 189 patients had a history of hypertension.The hospitalization cost of Stanford A after surgery was(245.8±6.3)thousand yuan,and the hospitalization days were(17.85±10.92)days.While the hospitalization cost of Stanford type B patients was(174.1±5.5)thousand yuan,and the hospitalization days were(17.26±11.84)days.Conclusion The number of male patients with acute aortic dissection is greater than that of female patients,the incidence of male patients is relatively young,and the incidence is on the rise.Chest,back or abdominal pain is as the first symptom of most acute aortic dissection.Hypertension is an independent risk factor.The correlation between smoking,drinking,diabetes and acute aortic dissection remains to be further confirmed.Surgical treatment is still the key to reduce the mortality of this kind of disease,and with the improvement of the diagnosis and treatment technology of aortic dissection,the in-hospital mortality is gradually decreasing.