| 赵永波,岳月红,王彦芝,赵伟超,冯光兴.急性Stanford A型主动脉夹层患者的临床特征及术后院内死亡危险因素分析[J].现代生物医学进展英文版,2019,19(7):1362-1366. |
| 急性Stanford A型主动脉夹层患者的临床特征及术后院内死亡危险因素分析 |
| Clinical Characteristics and Risk Factors of Postoperative Hospital Mortality in Patients with Stanford Type A Acute Aortic Dissection |
| Received:September 23, 2018 Revised:October 18, 2018 |
| DOI：10.13241/j.cnki.pmb.2019.07.037 |
| 中文关键词: 急性Stanford A型主动脉夹层 临床特征 死亡 危险因素 |
| 英文关键词: Stanford type A acute aortic dissection Clinical characteristics Mortality Risk factors |
| 基金项目:河北省医学科学研究重点项目（20150324） |
| Author Name | Affiliation | E-mail | | ZHAO Yong-bo | Department of Cardiovascular Surgery, Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050011, China | zsgonp@163.com | | YUE Yue-hong | Department of Neurology, HeBei General Hospital, Shijiazhuang, Hebei, 050003, China | | | WANG Yan-zhi | Department of Cardiac Surgery, HeBei General Hospital, Shijiazhuang, Hebei, 050003, China | | | ZHAO Wei-chao | Department of Cardiovascular Surgery, Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050011, China | | | FENG Guang-xing | Department of Cardiovascular Surgery, Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050011, China | |
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| 中文摘要: |
| 摘要 目的：研究急性Stanford A型主动脉夹层（AAAD）患者的临床特征，并分析影响其术后院内死亡的危险因素。方法：选取2015年6月~2018年4月河北医科大学第四医院心脏血管外科收治的279例 AAAD患者为研究对象，收集患者的基本信息、临床资料，分析 AAAD患者的临床特征。所有患者均行手术治疗，按照术后院内的死亡情况将患者分为死亡组和存活组，收集两组患者手术相关信息，采用多因素logistic回归分析对患者术后死亡的危险因素进行分析。结果： 279例AAAD患者中，男女比例为2.88:1；患者平均年龄为（52.11±8.91）岁；合并高血压者占66.67%，合并冠心病者占11.47%；患者以胸痛或胸背痛为主要症状（占69.89%）；并发症中以心包积液（占43.37%）和主动脉瓣反流（占18.64%）的发生率最高；其平均收缩压、白细胞计数、D-二聚体（DDi）水平均高于正常值上限；心、肾功能不全的发生率分别为23.30%和15.77%；院内死亡率为17.92%。单因素分析结果显示，死亡组和存活组AAAD患者在年龄、是否伴有肾功能不全、是否伴有心功能不全、DDi水平、体外循环时间、手术时间、输血量和术后是否开胸止血方面比较，均有统计学差异（P<0.05）。多因素logistic回归分析结果显示，年龄>65岁、伴有肾功能不全、体外循环时间≥270 min和术后开胸止血是AAAD患者术后死亡的独立危险因素（P<0.05）。结论：AAAD患者发病年龄呈年轻化，多数合并有基础疾病，疼痛为其主要症状，且该病患者并发症多、术后死亡率较高。年龄>65岁、伴有肾功能不全、体外循环时间≥270 min和术后开胸止血均可显著增加AAAD患者术后死亡风险。 |
| 英文摘要: |
| ABSTRACT Objective: To study the clinical characteristics of Stanford type A acute aortic dissection (AAAD) and analyze the risk factors of postoperative hospital mortality. Methods: 279 patients with AAAD who were admitted to the Department of Cardiovascular Surgery of the Fourth Hospital of Hebei Medical University from June 2015 to April 2018 were selected as the objects. The basic infor- mation and clinical data of patients were collected, and the clinical characteristics of AAAD patients were analyzed. All patients under- went surgical treatment, the patients were divided into death group and survival group according to the death situation in postoperative hospital. And the relevant surgical information was collected from the two groups. The risk factors of postoperative death were analyzed by multivariate logistic regression analysis. Results: In the 279 patients with AAAD, the ratio of male to female was 2.88:1. The average age of the patients was (52.11±8.91) years. Combined with hypertension was 66.67%, combined with coronary heart disease was11.47%. The main symptoms were chest pain and chest back pain (occupying 69.89%). The highest incidence of complications were pericardial effusion (occupying 43.37%) and aortic regurgitation (occupying 18.64%). The mean systolic blood pressure, white blood cell count and D-two polymer(DDi) levels were higher than the upper limit of normal values. The incidence of cardiac and renal insufficiency were 23.30% and 15.77% respectively. Hospital mortality was 17.92%. Single factor analysis showed that there were significant differ- ences in age, renal insufficiency, cardiac insufficiency, DDi level, cardiopulmonary bypass time, operation time, blood transfusion vol- ume and postoperative thoracotomy for hemostasis in the AAAD patients of the death group and the survival group (P<0.05). Multivari- ate logistic regression analysis showed that age>65, with renal insufficiency, cardiopulmonary bypass time≥270 min and postoperative thoracotomy for hemostasis were independent risk factors for postoperative mortality in patients with AAAD (P<0.05). Conclusion: The onset age of AAAD patients is younger, most of them have underlying diseases, and pain is the main symptom. There are many complica- tions and high postoperative mortality. The age>65 years, with renal insufficiency, cardiopulmonary bypass time≥270 min and postoper- ative open heart hemostasis are significantly increased the risk of postoperative mortality in patients with AAAD. |
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