急性主动脉夹层Stanford A型术前猝死危险因素分析  

Risk factors for preoperative sudden death in patients with Stanford A acute aortic dissection

作　　者：罗骏[1] 姚莉君[1] 邵月 陈丹[1] 张诚[1] LUO Jun;YAO Lijun;SHAO Yue;CHEN Dan;ZHANG Cheng(Department of Cardiothoracic Surgery,the first Affiliated Hospital of Chongqing Medical University,Chongqing 400016,China)

机构地区：[1]重庆医科大学第一附属医院胸心外科,重庆400016

出　　处：《西南医科大学学报》2020年第3期263-267,共5页Journal of Southwest Medical University

基　　金：重庆市科学技术局项目(cstc2017jcyjAX0109);重庆市卫生健康委员会项目(2019GDRC008)。

摘　　要：目的:对急性主动脉夹层Stanford A型术前猝死的患者进行危险因素分析,旨在对Stanford A型术前患者进行危重程度预估,制定准确的治疗方案。方法:选取本院2015年7月至2019年11月急诊收入胸心外科ICU的Stanford A型主动脉夹层患者111例,其中15例患者放弃治疗,96例患者接受治疗纳入研究,通过术前猝死与否分为术前猝死组37例和对照组59例,猝死组为术前死亡患者,对照组为成功接受手术治疗患者。收集纳入患者的临床资料进行统计学分析。结果:先进行单因素方差分析,选取P<0.05的因素,包括年龄、收缩压、舒张压、脉压差、吸烟、白细胞总数(WBC)、中性粒细胞总数、D-二聚体、纤维蛋白原、凝血酶原时间以及收缩压高于180 mmHg。选取其中明显关联的因素进入多因素Logistic回归分析,其中年龄、WBC和收缩压有统计学意义,根据OR得到与猝死相关独立危险因素。结论:高龄、高WBC和低收缩压为急性主动脉夹层Stanford A型患者术前死亡的独立危险因素,临床医师在首诊主动脉夹层患者时,需格外注意,以选择适当的手术和治疗。Objective:To investigate the risk factors for preoperative sudden death in patients with Stanford A acute aortic dissection,and to predict the severity of Stanford A aortic dissection and develop accurate treatment plan before surgery.Methods:A total of 111 patients with Stanford A aortic dissection who were admitted to the In⁃tensive Care Unit of Department of Cardiothoracic Surgery in our hospital from July 2015 to November 2019 were se⁃lected,among whom 15 patients abandoned treatment and 96 patients received treatment and were enrolled in this study.According to whether preoperative sudden death was observed,the 96 patients were divided into sudden death group with 37 patients(who died before surgery)and control group with 59 patients(who underwent surgical treatment successfully).The clinical data of the patients were collected for statistical analysis.Results:A one-way analysis of variance showed that there were significant differences between the two groups in age,systolic pressure,diastolic pressure,pulse pressure,smoking,white blood cell count(WBC),neutrophils,D-dimer,fibrinogen,and prothrombin time(P<0.05).The factors with significant correlation were included in the multivariate logistic regression analysis,and the results showed significant differences in age,systolic pressure,and WBC,which were positively correlated with sudden death.Conclusion:Age,systolic pressure,and WBC are independent risk fac⁃tors for preoperative sudden death in patients with Stanford A acute aortic dissection.Clinicians should pay special attention to these factors at initial diagnosis,so as to select appropriate surgery and treatment.

关 键 词：急性主动脉夹层 Stanford A型 术前猝死 危险因素 

分 类 号：R714.252[医药卫生—妇产科学]