主动脉夹层动脉瘤患者不同Stanford分型的临床特征分析及意义  

Analysis on clinical features of patients with aortic dissection in different Stanford types

作　　者：吴锦鸿[1] 许国根[1] 章浩[1] 陈雯[1] 王弋[1] 

机构地区：[1]浙江省杭州市第一人民医院急诊科,310006

出　　处：《中华危重症医学杂志（电子版）》2010年第5期20-23,共4页Chinese Journal of Critical Care Medicine:Electronic Edition

摘　　要：目的分析主动脉夹层动脉瘤患者不同Stanford分型的相关临床特征,探讨其影响预后的危险因素及其意义。方法收集主动脉夹层动脉瘤患者病例79例,按Stanford分型分为A型组26例和B型组53例,回顾性分析两组患者的临床资料,观察病情变化及预后。结果 Stanford A型患者的胸痛、背痛、胸闷气促和意识障碍的发生率高于Stanford B型患者,差异均有统计学意义(P均<0.05);而腹痛、腰痛和无症状的发生率Stanford B型患者要高于Stanford A型患者,差异均有统计学意义(P均<0.05)。Stanford A型患者的就诊时间、平均年龄、入院时血压和既往有高血压史的病例均少于Stanford B型患者,而既往有马凡综合征病史的病例Stanford A型高于Stanford B型,差异均有统计学意义(P均<0.05)。Stanford A型患者的心包积液和意识障碍的发生率及死亡率均高于Stanford B型患者(P<0.05)。结论主动脉夹层动脉瘤Stanford A型患者的发病年龄相对较轻,病情凶险,并发心包积液,心力衰竭和意识障碍的发生率和死亡率高。明确诊断为Stanford A型主动脉动夹层动脉瘤或是Stanford B型患者出现心包积液、胸腔积液等并发症是提示患者死亡的危险指标。Objective To analyze the clinical features of patients with aortic dissection in different Stanford types, and explore the risk factors and prognostic significance. Methods Seventy-nine patients with aortic dissection were divided into type A group （26 cases） and type B group （53 cases） according to different Stanford types. The clinical data of the two groups were retrospective analyzed, and the condition changes and prognosis were observed. Results The incidence of chest pain, back pain, chest distress, breathlessness and disturbance of consciousness in the type A group was statistically higher than the type B （all P〈O.05）. However, the incidence of abdominal pain, waist pain, and non-symptom in the type B was obviously higher than the type A （all P〈0.05）. The data about treatment course, average age, and blood pressure on admission in the type A was lower than the type B. Moreover, the number of cases complicated with hypertension was smaller in type A than the type B, while with Marfan syndrome was larger （all P〈0.05）. Incidence of pericardial effusion and conscious disturbance and the mortality rate in the type A was significantly higher than the type B （all P〈 0.05）. Conclusions Patients with aortic dissection in Stanford type A present with younger onset age, more severe condition, higher complication incidence and mortality. Comfirmed digonosis of aortic dissection in Stanford type A or Stanford type B complicated with pericardial or pleural effusion may be the risk signs of death.

关 键 词：主动脉夹层 Stanford分型 临床特征 

分 类 号：R543.1[医药卫生—心血管疾病]