Analysis of clinical features of patients with aortic dissection in a third class hospital of Ningxia in ten years
ZHENG Donglian1 GUO Shuping1 MA Fuzhen1 JI Shuangdui2 MA Shilin2 ZHAO Rong1
1.Department of Cardiac and Vascular Surgery,General Hospital of Ningxia Medical University,Ningxia Hui Autonomous Region,Yinchuan 750000,China;
2.School of Nursing,Ningxia Medical University,Ningxia Hui Autonomous Region,Yinchuan 750000,China
摘要 目的 分析10 年间就诊于某单中心的主动脉夹层住院患者人口学资料、临床特征、临床分型及时间变化趋势。方法 回顾性收集2011 年1 月至2020 年12 月宁夏医科大学总医院651 例明确诊断为主动脉夹层患者的相关资料，包括社会人口学资料、临床症状、合并症、发病诱因、家族遗传史、治疗方式及住院转归等，并分析Stanford A 型、Stanford B 型患者死亡的影响因素。结果 10 年间主动脉夹层住院患者人数整体呈逐步上升趋势，Stanford A 型患者占39.63%，Stanford B 型患者占60.37%，男女比为3.62∶1，平均年龄（52.88±11.46）岁。14.75%的患者诉发病有明确诱因，主要以体力活动和外力撞击为主，10.91%的患者诉有明确家族遗传史。临床症状方面，96.31%的患者有明显疼痛，其中胸部、背部和腹部发生比例较高，依次为66.97%、62.83%和32.26%。不同分型主动脉夹层住院患者在保守治疗方面的临床结局比较，差异有统计学意义（P＜0.05）。多因素logistic 回归分析结果显示，早期急诊手术是预防Stanford A 型主动脉夹层患者死亡的保护因素，喝酒是患者院内死亡的危险因素（P＜0.05）。控制收缩压在适宜范围内是Stanford B 型主动脉夹层患者院内死亡的保护因素，住院时间和保守治疗是其院内死亡的危险因素（P＜0.05）。结论 早期急诊手术是预防Stanford A 型主动脉夹层患者死亡的保护因素，控制收缩是Stanford B 型主动脉夹层患者院内死亡的保护因素，因此明确主动脉夹层死亡危险因素，可为临床诊疗提供参考依据。
Objective To analyze the demographic data,clinical characteristics,clinical types and time trends of hospitalized patients with single-center aortic dissection in ten years.Methods The relevant data of 651 patients diagnosed with major arterial dissection in the General Hospital of Ningxia Medical University from January 2011 to December 2020 were retrospectively collected,including socio-demographic data,clinical symptoms,comorbidities,pathogenesis,family genetic history,treatment methods and hospitalization outcomes,etc.The influencing factors of death in Stanford type A and Stanford type B patients were analyzed.Results In the past 10 years,the number of hospitalized patients with aortic dissection showed A gradual upward trend,and Stanford type A patients accounted for 39.63%and Stanford type B patients accounted for 60.37%,with a male-to-female ratio of 3.62∶1 and an average age of (52.88±11.46)years.14.75%of the patients reported definite inducement,mainly physical activity and external impact,10.91%of the patients reported definite family genetic history.In terms of clinical symptoms,96.31%of the patients had obvious pain,among which the chest,back and abdomen were the highest (66.97%,62.83% and 32.26%).There was statistical significance in clinical outcomes of different types of aortic dissection patients in conservative treatment(P＜0.05).Multivariate logistic regression analysis showed that early emergency surgery was A protective factor for the prevention of death in Stanford Type A aortic dissection patients,and drinking was a risk factor for hospital death (P＜0.05).Control of systolic blood pressure within the appropriate range was a protective factor for in-hospital death in Stanford type B aortic dissection patients,and length of stay and conservative treatment were risk factors for in-hospital death (P＜0.05).Conclusion Early emergency surgery is A protective factor for preventing death in Stanford type A aortic dissection patients,and controlled contraction is a protective factor for in-hospital death in Stanford type B aortic dissection patients.Therefore,identifying the risk factors for death of aortic dissection can provide a reference for clinical diagnosis and treatment.
郑栋莲; 郭淑萍; 马富珍;吉双对;马世林; 赵荣. 宁夏某三甲医院10 年间主动脉夹层患者的临床特征分析[J]. 中国当代医药, 2024, 31(16): 4-9.
ZHENG Donglian1 GUO Shuping1 MA Fuzhen1 JI Shuangdui2 MA Shilin2 ZHAO Rong1. Analysis of clinical features of patients with aortic dissection in a third class hospital of Ningxia in ten years. 中国当代医药, 2024, 31(16): 4-9.
Malaisrie SC，Szeto WY，Halas M，et al.The American Association for Thoracic Surgery expert consensus document：Surgical treatment of acute type A aortic dissection[J].J Thorac Cardiovasc Surg，2021，162（3）：735-758.
[4]
李京杭，戚晓通.急性Stanford A 型主动脉夹层患者临床特征及院内死亡的相关因素分析[J].南京医科大学学报，2018，38（1）：95-98.
[5]
Bossone E，Eagle KA.Epidemiology and management of aortic disease：aortic aneurysms and acute aortic syndromes[J].Nat Rev Cardiol，2021，18（5）：331-348.
Erbel R，Aboyans V，Boileau C，et al.ESC Committee for practice Guidelines.2014 ESC Guidelines on the diagnosis and treatment of aortic diseases：Document covering acute and chronic aortic diseases of the thoracic and abdominal aorta of the adult.The Task Force for the Diagnosis and Treatment of Aortic Diseases of the European Society of Cardiology（ESC）[J].Eur Heart J，2014，35（41）：2873-2926.
Evangelista A，Isselbacher EM，Bossone E，et al.Insights from the international registry of acute aortic dissection：A 20 year experience of collaborative clinical research[J].Circulation，2018，137（17）：1846-1860.
[11]
Villahoz S，Yunes -Leites PS，Méndez-Barbero N，et al.Conditional deletion of Rcan1 predisposes to hypertension-mediated intramural hematoma and subsequent aneurysm and aortic rupture[J].Nat Commun，2018，9（1）：4795-4798.
Velayudhan BV，Idhrees M，Matalanis G，et al.Current status in decision making to treat acute type A dissection：limited versus extended repair[J].J Cardiovasc Surg，2020，61（3）：285-291.
Eranki A，Merakis M，Williams ML，et al.Outcomes of surgery for acute type A dissection in octogenariansversusnon-octogenarians：a systematic review and meta analysis[J].J Cardiothorac Surg，2022，17（1）：222-223.
京公网安备 11010502046607号