A型主动脉夹层入院时收缩压水平对住院死亡的影响  

The Association between Systolic Blood Pressure Level on Admission and In-hospital Death in Patients with Stanford Type A Acute Aortic Dissection

作　　者：韩忠丽[1,2] 刘思斯[1] 陈昭然[1] 牛宇婷[3] 惠汝太 杨艳敏[1] 杨晓敏[2] 张澍[1] 樊晓寒[1] 

机构地区：[1]中国医学科学院北京协和医学院国家心血管病中心阜外医院心血管疾病国家重点实验室心内科,北京市100037 [2]包头医学院研究生院,包头市014030 [3]北京大学附属中学,北京市100037

出　　处：《中国分子心脏病学杂志》2016年第2期1636-1639,共4页Molecular Cardiology of China

基　　金：国家自然科学基金资助项目(81441017)

摘　　要：目的探讨A型急性主动脉夹层患者入院时收缩压水平对住院死亡风险的影响。方法研究对象为2008年至2010年到阜外医院就诊经主动脉CT证实诊断为Stanford A型急性主动脉夹层患者共595例,收集患者的基线资料、入院时血压水平、治疗策略及其住院死亡情况。按患者入院时收缩压水平分为四组,比较住院死亡率及其影响因素。结果血压降低组(收缩压<90mmHg)的住院死亡率显著高于正常血压组(90mmHg≤收缩压<140mmHg)和血压轻度增高(140mmHg≤收缩压<160mmHg)及显著增高组(收缩压≥160mmHg)(45%vs.8.5%vs.9.7%vs.14.5%,P<0.05)。接受外科手术治疗患者中,血压降低组与其他组比较住院死亡率无显著差异(0%vs.0.5%,P>0.05),药物保守治疗患者中血压降低组住院死亡率显著高于其他组(81.8%vs.31%,P<0.05)。经多因素COX生存分析校正年龄和性别等因素后,入院时收缩压降低增加2.35倍的住院死亡危险(HR 2.35,95%CI 1.14-4.87,P=0.031),住院死亡的独立影响因素还包括基线血肌酐水平、白细胞计数、血小板计数及是否接受外科治疗。结论 A型主动脉夹层患者入院时的收缩压水平低于90mmHg时接受药物保守治疗的院内死亡风险较高,应尽早考虑接受外科手术治疗改善预后。Objective To evaluate the association of systolic blood pressure（SBP） Icvelson admission with in-hospital death in patients with Stanford type A acute aortic dissection（AAD）.Methods This study enrolled 595 patients with Stanford type A AAD who were confirmed by aortic CT in Fuwai hospital from 2008 to 2010.We collected baseline clinical data and treatment strategies of all patients.The primary endpoint was in- hospital death.According to SBP levels on admission,all patients were divided into four groups,and inhospital mortality and influence factors were analyzed.Results The in-hospital mortality was significantly higher in the low SBP group（SBP≤90mmHg） than that in the normal SBP group（90mmHg ≤ SBP 40mmHg）,the increased SBP group（140mmHg≤ SBP160mmHg）,and the high SBP group（SBP ≥160mmHg）（45%vs.8.5%vs.9.7%vs.14.5%,P0.05）.In patients receiving surgical intervention,the inhospital inortality was similar between the low SBP group and the other groups（0%vs.0.5%,P 〈0.05）.In patients receiving conversational treatment with medicines,the in-hospital mortality was significantly higher in low SBP group than that in other groups（81.8%vs.31%,P0.05）.After adjustment for age,sex,and other factors by using multivariate COX regression analysis,the lowSBP on admission was significantly associated with increased risk of in-hospital death（OR 2.35,95%C1 1.14-4.87,P=0.03 1）.The in-hospital death was also independently associated with baseline scrum creatinine,white blood cell count,platelet count and surgical intervention.Conclusion Patients with Stanford type A AAD might be at high risk of in-hospital death if their SBP on admission was less than 90 mmHg.Those patients with low SBP level should receive surgical intervention soon instead of conversational treatment.

关 键 词：A型急性主动脉夹层 血压水平 治疗策略 住院死亡 

分 类 号：R543.1[医药卫生—心血管疾病]