不同年龄胸降主动脉扩张性疾病患者腔内隔绝术疗效分析  

Clinical effect of endovascular stent-graft repair in different age patients with thoracic aortic aneurysm

作　　者：李娜[1] 刘艳杰[1] 王效增[1] 周铁楠[1] 赵昕[1] 荆全民[1] LI Na;LIU Yan-jie;WANG Xiao-zeng;ZHOU Tie-nan;ZHAO Xin;JING Quan-min(Department of Cardiology,General Hospital of Shenyang Military Region,Shenyang 110016,China)

机构地区：[1]沈阳军区总医院心血管内科,沈阳110016

出　　处：《岭南心血管病杂志》2017年第6期695-699,共5页South China Journal of Cardiovascular Diseases

摘　　要：目的比较不同年龄胸降主动脉扩张性疾病患者的临床特点及腔内隔绝术治疗的近、远期疗效。方法 2002年4月至2016年6月沈阳军区总医院767例胸降主动脉扩张性疾病患者接受主动脉腔内隔绝术治疗。根据年龄分为中青年组(<60岁,n=480)和老年组(≥60岁,n=287)。随访1~170个月,平均(40.6±30.5)个月。分析其临床和影像资料。比较两组患者行腔内隔绝术的近、远期疗效。结果中青年组的胸降主动脉扩张性疾病的发病率高于老年组,差异有统计学意义(P=0.049);而老年组合并冠状动脉粥样硬化性心脏病(冠心病)、脑血管病及心功能不全的发病率高于中青年组,差异有统计学意义(P<0.001);中青年组舒张压高于老年组,差异有统计学意义[(90.4±17.8)mmHg vs.(85.5±16.1)mmHg,P=0.017;1 mmHg=0.133 kPa];中青年组与老年组性别、原发性高血压(高血压)、糖尿病、吸烟、饮酒、肥胖等患者比例比较,均差异无统计学意义(P>0.05)。长期随访发现,两组间并发症如截瘫、脑梗死及造影剂肾病的发生率比较,差异无统计学意义(P>0.05);老年组远期主动脉源性病死率明显高于中青年组,差异有统计学意义(P=0.005)。结论腔内隔绝术治疗胸降主动脉扩张性疾病安全有效,虽然年龄对主动脉腔内隔绝术的术后疗效有一定影响,但其仍是目前胸降主动脉扩张性疾病首先治疗方案。Objectives To compare the clinical features of different age patients with thoracic aortic aneurysm,and an?alyze the therapeutic effect of endovascular stent-graft repair in these patients.Methods From April2002to June2016,767patients with thoracic aortic aneurysm underwent stent-graft implantation in General Hospital of Shenyang Military Region were enrolled.The patients were divided into middle-aged group(<60years old,n=480)and elderly group(≥60years old,n=287).Follow-up visit ranged from1to170months,mean(40.6±30.5)months.Clinical date of these patients were collected and analyzed.Short-term and long-term therapeutic effects of endovascular stentgraft repair were compared between the two groups.Results Incidence of thoracic aortic aneurysm in middle-aged group was significantly higher than that in elderly group(P=0.049).Incidences of coronary artery diseases,cerebrovas?cular disease and cardiac insufficiency in elderly group were significantly higher than those in middle-aged group(P<0.001).Diastolic pressure in middle-aged group was obviously higher than that in in elderly group[(90.4±17.8)mmHg vs.(85.5±16.1)mmHg,P=0.017;1mmHg=0.133kPa].There were no significant differences of percentages of patients with sexuality,essential hypertension,diabetes mellitus,smoking,drinking,adiposity between the two groups(P>0.05).Incidences of complications such as paraplegia,cerebral infarction,contrast-induced nephropathy between the two group had no significant differences(P>0.05).Long term mortality of aortic origin diseases was obviously higher in elderly group than in middle-aged group(P=0.005).Conclusion Endovascular stent-graft repair is effective for treat?ment of thoracic aortic aneurysm,though its postoperative curative effect could be affected by age.

关 键 词：胸主动脉扩张性疾病 主动脉腔内隔绝术 年龄 血管成形术 经腔 经皮冠状动脉 

分 类 号：R543.1[医药卫生—心血管疾病]