老年Stanford A型主动脉夹层患者的临床特点及不良事件分析  

Clinical characteristics of elderly patients with Stanford type A aortic dissection and analysis of adverse events in hospital

作　　者：胡国智[1] 肖红艳[1] 罗萍[1] HU Guo-zhi;XIAO Hong-yan;LUO Ping(Department of Cardiac Surgery,Wuhan Asia Heart Hospital,Hubei Wuhan 430022,China)

机构地区：[1]武汉亚洲心脏病医院心外科

出　　处：《中国医刊》2020年第1期43-46,共4页Chinese Journal of Medicine

基　　金：湖北省卫生健康委员会科研项目(WJ2019F024)

摘　　要：目的探讨老年Stanford A型主动脉夹层患者的临床特点及院内不良事件发生情况,为临床诊治提供参考。方法选择2016年1月至2018年12月武汉亚洲心脏病医院收治的38例老年(≥60岁)Stanford A型主动脉夹层患者作为研究对象(观察组),以同期入院的76例年龄<60岁的Stanford A型主动脉夹层患者作为对照组,总结分析两组患者的性别、吸烟史、饮酒史、合并症和既往史等一般资料,红细胞计数、白细胞计数、血小板计数及血红蛋白、谷丙转氨酶、肌酐、尿素氮、空腹血糖、血脂水平等实验室指标,左室舒张期末内径、左室射血分数、假腔血栓率、胸腔积液率、心包积液率等影像学指标,以及住院用药(利尿剂、硝酸酯类、硝普钠、β受体阻滞剂、血管紧张素转换酶抑制剂/血管紧张素受体拮抗剂、钙离子拮抗剂)、手术干预率和不良事件发生率的差异。结果观察组患者的男性比例、饮酒比例低于对照组,年龄、糖尿病比例、高血压比例高于对照组,差异有显著性(P<0.05)。观察组患者的血红蛋白水平及左室舒张期末内径低于对照组,差异有显著性(P<0.05)。两组住院用药情况比较差异无显著性(P>0.05)。观察组手术干预率和术后急性肝衰竭、主动脉夹层破裂出血发生率低于对照组(P<0.05),但院内全因病死率高于对照组(P<0.05)。结论老年Stanford A型主动脉夹层患者合并症多,院内病死率高,预后差,故应强化风险意识,采取有针对性的措施改善预后。Objective To explore the clinical characteristics of elderly patients with Stanford type A aortic dissection and the occurrence of adverse events in hospital, so as to provide reference for clinical diagnosis and treatment. Method According to age, 38 patients aged over 60 years were classified as the elderly group, and 76 patients aged under 60 years were classified as the non-elderly group. The general data of sex, smoking history, alcoholism history and past history of the two groups were summarized and analyzed. The differences of laboratory indexes between the two groups were compared, such as red blood cell count, white blood cell count, hemoglobin, platelet count, alanine aminotransferase, serum creatinine, urea nitrogen, fasting blood sugar and blood lipid. The differences of left ventricular end diastolic diameter, left ventricular ejection fraction, false lumen thrombosis rate, pleural effusion rate and pericardial effusion rate between the two groups were compared. The differences of diuretics, nitrates, sodium nitroprusside, beta-blockers, angiotensinconverting enzyme inhibitors/angiotensin receptor antagonists and surgical intervention rates between the two groups were compared. The incidence of adverse events between the two groups was compared. Result The ratio of male and drinking in elderly group were lower than those in non-elderly group, and the difference was statistically significant(P<0.05). The hemoglobin level and left ventricular end-diastolic diameter in the observation group were lower than those in the control group, with significant differences(P< 0.05). The elderly group had a higher age, a higher proportion of diabetes history and a higher proportion of hypertension(P<0.05). The level of Hb in the elderly group was lower than that in the non-elderly group(P<0.05). The LVEDD of the elderly group was lower than that of the non-elderly group(P<0.05). There was no significant difference in drug use rate between the two groups(P>0.05). The surgical intervention rate in the elderly group

关 键 词：主动脉夹层 Stanford A型 老年人 临床特点 

分 类 号：R654.3[医药卫生—外科学]