急、慢性降主动脉夹层腔内修复术的单中心对比分析  

Comparison of clinical outcomes between patients with acute and chronic Stanford type B aortic dissection treated with endovascular aortic repair in a single center

作　　者：周铁楠[1] 王雅[1] 王效增[1] 何瑞霞[1] 荆全民[1] 韩雅玲[1] 

机构地区：[1]沈阳军区总医院心内科,沈阳110016

出　　处：《岭南心血管病杂志》2016年第4期376-381,共6页South China Journal of Cardiovascular Diseases

基　　金：辽宁省科技计划项目(项目编号:2012225009)

摘　　要：目的比较急性和慢性降主动脉夹层行腔内修复(endovascular aortic repair,EVAR)治疗的近、远期临床疗效。方法回顾性分析沈阳军区总医院2002年4月至2014年12月的456例(急性期342例,慢性期114例)诊断为降主动脉夹层,并行EVAR治疗的患者的临床特点及手术参数等临床资料,并对术后近、远期临床随访结果进行对比分析。同时,分析降主动脉夹层患者的临床特征与术后死亡的关系。结果与慢性期组比较,急性期组前胸及后背部疼痛、胸腔积液、急性肾功能不全、D-二聚体(>0.5 ng/mL)的患者比例显著升高,差异均具有统计学意义(P均<0.05)。急性期组入院收缩压、入院心率高于慢性期组,差异有统计学意义(P<0.001)。两组间EVAR相关参数比较,差异均无统计学意义(P>0.05)。术后近期结果(术后30 d内):两组间全因病死率,主动脉源性死亡、内漏、截瘫、再发夹层、主动脉夹层破裂、急性肾功能不全患者比例比较,差异均无统计学意义(P>0.05)。远期随访结果(术后30 d以后):两组间病死率,内漏、再发夹层、主动脉夹层破裂的患者比例比较,差异均无统计学意义(P>0.05)。Logistic回归分析显示人院胸腔积液(OR=39.793;95%aCI:12.540-126.269;P<0.001)、冠状动脉粥样硬化性心脏病(冠心病)(OR=4.724;95%CI:1.921-11.617;P=0.001)与EVAR术后死亡存在独立相关性。结论 EVAR治疗Stanford B型主动脉夹层安全有效,但是急性期患者术后近期病死率较慢性期具有增高趋势,两组间远期病死率相近;胸腔积液、冠状动脉粥样硬化性心脏病为EVAR术后死亡的独立危险因素。Objectives To analyze the differences of early and long-term clinical outcomes after endovascular aortic repair （EVAR） for patients with acute and chronic Stanford type B aortic dissection. Methods From April 2002 to December 2014, a total of 456 patients with Stanford type B aortic dissection were treated with EVAR in General Hospital of Shenyang Military Region. These patients were divided into two groups depending on the onset time ： acute group was within 14 days （n=342） and chronic group was over 14 days （n=l14）. Data including clinical characteristics, procedural characteristics, early and long-term outcomes in follow-up were retrospectively analyzed. Relation of clinical characteristics and mortality after operation was also analyzed. Results Compared with chronic group, the patients proportion in acute group were higher in D-dimer （〉0.5 ng/mL）, chest or back pain, pleural effusion, acute renal insufficiency（P〈0.05）. In addition, acute group had higher pulse and systolic blood pressure on admission （P〈0.05）. In follow-up within and over 30 days, all-cause mortality, aortic-related mortality and aortic- related complications （endoleak, paraplegia, redissection, aortic rupture and acute renal insufficiency） had no statistical difference in the two groups in early and long-term outcomes （P〉0.05）. Logistic regression analysis showed that pleural effusion on admision and coronary artery disease could predict mortality after EVAR （OR=39.793; 95%CI： 12.540-126.269; P〈0.001; OR=4.724; 95%CI： 1.921-11.617; P=0.001）. Conclusions There is no statistical difference in mortality of Stanford type B aortic dissection treated with EVAR in early and long-term follow-up, whereas the early mortality is higher in acute group. Pleural effusion and coronary artery disease are the independent risk factors of mortality after EVAR.

关 键 词：降主动脉夹层 急性期 慢性期 主动脉腔内隔绝术 病死率 

分 类 号：R543.16[医药卫生—心血管疾病]