急性A型主动脉夹层和壁内血肿的早期生存状况分析  

Early survival analysis of acute type A aortic dissection and intramural hematoma

作　　者：畅怡[1] 林宏远 郭宏伟[1] CHANG Yi;LIN Hongyuan;GUO Hongwei(Department of Vascular Surgery,Fuwai Hospital,National Center for Cardiovascular Diseases,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing,100037,P.R.China)

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血管外科中心,北京100037

出　　处：《中国胸心血管外科临床杂志》2020年第9期1025-1030,共6页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

基　　金：中国医学科学院体制改革经费(2018-F02)。

摘　　要：目的探讨急性A型主动脉夹层和壁内血肿患者的早期临床转归。方法回顾性分析2020年1月23日至3月10日于我院就诊的61例急性A型主动脉夹层和壁内血肿患者的临床资料,其中男43例、女18例,年龄22~81(52.1±13.0)岁。对患者的就诊时间、临床特点、早期生存情况进行分析。生存分析使用KaplanMier生存曲线以及log-rank检验。结果急性A型主动脉夹层患者48例(78.7%),壁内血肿患者13例(21.3%)。34例患者接受手术,其中11例在24 h内接受急诊手术,手术死亡率2.9%。全组61例患者中存活48例、死亡13例。所有患者术后1 d、3 d和7 d累积生存率分别为93.4%、86.4%和77.5%;夹层患者术后1 d、3 d和7 d的累积生存率分别为95.7%、88.7%和79.4%,血肿患者术后1 d、3 d和7 d的累积生存率分别为92.3%、84.6%和84.6%,经log-rank检验,生存率差异无统计学意义(P>0.05)。所有患者术后14 d生存率为74.5%,夹层和血肿患者术后14 d生存率差异无统计学意义(P>0.05)。对比存活患者和死亡患者,两组血流动力学不稳定状态的患者占比差异有统计学意义(P<0.05)。结论存活至就诊的急性主动脉夹层和壁内血肿患者在积极药物治疗下仍有死亡风险,夹层破裂是该类患者死亡的首要原因,特别是血流动力学不稳定的患者。Objective To explore the early clinical outcomes of patients with acute type A aortic dissection and intramural hematoma.Methods The clinical data of 61 patients with acute type A aortic dissection or intramural hematoma in our hospital from January 23,2020 to March 10,2020 were retrospectively analyzed,including 43 males and18 females,aged 22-81(52.1±13.0) years.The patient’s time of visit,clinical characteristics and early survival were analyzed.Kaplan-Mier survival curve and log-rank test were used for the survival analysis.Results There were 48(78.7%) patients diagnosed with acute type A aortic dissection and 13(21.3%) patients with intramural hematoma;34 patients received operation and 11 were emergent.The 30-day mortality was 2.9% among the patients receiving operation.There were 48 patients alive and 13 patients dead during the study period.The cumulative survival rates for all the patients on postoperative 1 day,3 days and 7 days were 93.4%,86.4% and 77.5%,respectively.The cumulative survival rates for the patients with dissection on postoperative 1 day,3 days and 7 days were 95.7%,88.7% and 79.4%,respectively.The cumulative survival rates for the patients with hematoma on postoperative 1 day,3 days and 7 days were 92.3%,84.6% and84.6%,respectively.The difference of survival rates between the two groups was not statistically significant(P>0.05).The cumulative survival rate of all the patients on postoperative 14 days was 74.5%.No statistically significant difference in survival rate on postoperative 14 days was found between patients with intramural hematoma and patients with aortic dissection(P>0.05).The proportions of the patients with unstable hemodynamics were found statistically significant between the survival patients and the dead patients(P<0.05).Conclusion Patients with acute aortic dissection and intramural hematoma who survive to the hospital still have the risk of death under active drug therapy,and rupture of the dissection is the leading cause of death in these patients,especially for tho

关 键 词：急性A型主动脉夹层 主动脉壁内血肿 外科手术 治疗 

分 类 号：R543.1[医药卫生—心血管疾病]