A型主动脉夹层患者术前猝死相关因素分析  

Analysis of Risk Factors of Preoperative Sudden Death of Patients with Type A Aortic Dissection

作　　者：范阜东[1] 张杰[1] 武忠[1] 周庆[1] 王强[1] 王东进[1] 

机构地区：[1]南京大学医学院附属鼓楼医院心胸外科,南京210008

出　　处：《中国胸心血管外科临床杂志》2012年第5期502-506,共5页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

基　　金：国家自然科学基金资助项目(81070241)~~

摘　　要：目的分析A型主动脉夹层患者术前猝死的相关因素,以指导临床治疗。方法回顾性分析南京大学医学院附属鼓楼医院心胸外科2003年1月至2010年1月52例A型主动脉夹层患者的临床资料,按患者术前是否猝死分为两组:术前猝死(PSD)组9例,男7例,女2例;年龄(52.0±12.1)岁;对照组43例,男31例,女12例;年龄(51.5±10.9)岁。应用单因素和多因素logistic回归分析探索患者术前猝死的相关因素。结果单因素分析筛选出7个候选变量:体重指数(BMI,Waldχ2=2.150,P=0.143)、发病时间(Waldχ2=2.711,P=0.100)、总胆固醇(TC,Waldχ2=1.444,P=0.230)、低密度脂蛋白胆固醇(L-C,Waldχ2=1.341,P=0.247)、主动脉瓣关闭不全(AI,Waldχ2=2.093,P=0.148)、夹层累及主动脉窦部(Waldχ2=3.386,P=0.066)和假腔血栓化(Waldχ2=7.743,P=0.005)。多因素分析结果表明,BMI(Waldχ2=4.215,P=0.040,OR=1.558)和夹层累及主动脉窦部(Waldχ2=4.592,P=0.032,OR=171.166)为术前猝死危险因素,假腔血栓化(Waldχ2=5.097,P=0.024,OR=0.011)为避免术前猝死的保护因素。结论 BMI较大和累及主动脉窦部的A型主动脉夹层患者需紧急接受手术治疗,而假腔血栓化患者术前猝死风险相对较小。Objective To analysis correlation factors for preoperative sudden death of patients with type A aortic dissection in order to determine clinical management strategy.Methods We retrospectively analyzed clinical data of 52 patients with type A aortic dissection who were admitted in Department of Cardiothoracic Surgery of the Affiliated Drum Tower Hospital of Nanjing University Medical School from January 2003 to January 2010.According to the presence of preoperative death,all the patients were divided into two groups,9 patients in the preoperative sudden death（PSD）group including 7 males and 2 females with their mean age of 52.0±12.1 years;43 patients in the control group including 31 males and 12 females with their mean age of 51.5±10.9 years.Univariate and multivariate logistic regression analysis were used for analysis of preoperative factors related to sudden death.Results Univariate analysis result showed 7 candidate variables：body mass index（BMI,Wald χ2=2.150,P=0.143）,time of onset（Wald χ2=2.711,P= 0.100）,total cholesterol（TC,Wald χ2=1.444,P=0.230）,low density lipoprotein cholesterol（L-C,Wald χ2=1.341,P=0.247）,aortic insufficiency（AI,Wald χ2=2.093,P=0.148）,aortic sinus involvement（Wald χ2=3.386,P=0.066）and false lumen thrombosis（Wald χ2=7.743,P=0.005）.Multivariate logistic regression analysis showed that BMI（Wald χ2=4.215,P=0.040,OR=1.558）and aortic sinus involvement（Wald χ2=4.592,P=0.032,OR=171.166）were preoperative risk factors for sudden death,and thrombosed false lumen（Wald χ2=5.097,P=0.024,OR=0.011）was preoperative protective factor for sudden death.Conclusion Type A aortic dissection patients with large BMI and/or aortic sinus involvement should receive operation more urgently than others and patients with thrombosed false lumen may have relatively low risk of preoperative sudden death.

关 键 词：A型主动脉夹层 术前猝死 LOGISTIC回归分析 

分 类 号：R543.16[医药卫生—心血管疾病] R654.2[医药卫生—内科学]