手术或保守-老年主动脉壁间血肿的艰难抉择  

Surgery treatment or medical treatment-difficult choice in elderly aortic hematoma

作　　者：刘鹏[1] 任永奎[2] LIU Peng;REN Yongkui(Department of Cardiac Intensive Care Unit,the First Affiliated Hospital of Dalian Medical University,Dalian,Liaoning,116011,China;Department of Cardiology,the First Affiliated Hospital of Dalian Medical University,Dalian,Liaoning,116011,China)

机构地区：[1]大连医科大学附属第一医院心脏重症监护科,辽宁大连116011 [2]大连医科大学附属第一医院心血管内科,辽宁大连116011

出　　处：《临床心血管病杂志》2020年第9期835-839,共5页Journal of Clinical Cardiology

基　　金：大连市医学科学研究计划项目(No:1912019)。

摘　　要：目的:老年合并主动脉壁内血肿(IMH)的临床分析。方法:选取2013年5月-2018年5月我院收治的所有老年IMH 104例,分为A型主动脉壁内血肿(IMH-A)组和B型主动脉壁内血肿(IMH-B)组。进行5年的随访研究,研究终点为死亡。结果:IMH-A组主动脉瓣关闭不全明显高于IMH-B组。IMH-B组外科手术治疗比例较低(23.8%),主要为主动脉覆膜支架植入术,IMH-A组则以升主动脉及主动脉半弓置换术为主的体外循环手术,两组比较差异有统计学差异。此外两组院内死亡率、全因死亡率相近,两组的中位生存时间分别为(49.0∶55.2)个月,经Log-rank检验无统计学意义(P=0.933)。亚组分析中,内科组、外科组中位生存时间分别为(53.9∶51.7)个月,但经Log-rank检验差异仍无统计学意义(P=0.875)。结论:老年IMH的首选治疗方式仍为内科治疗为主,外科治疗可能改善老年A型壁间血肿的预后。Objective:To analyze the elderly patients with intra-aortic hematoma(IMH).Method:The 104 patients with IMH were retrospectively included in this study from May 2013 to May 2018.They were divided into IMH-A group and IMH-B group according to imaging analysis.After the 5 year follow-up study was performed.The study endpoint was clinical death.Result:Aortic valve insufficiency was significantly higher in the IMH-A group than in the IMH-B group.IMH-B group had a lower surgical treatment ratio(23.8%).In terms of surgical treatment,All of the IMH-B group was treated with intracavity aorta and stent implantation.IMH-A group included aortic replacement under cardiopulmonary bypass.All-cause mortality was similar between the two groups.The survival times were(49.0 vs 55.2 months),and no significant difference was found by Log-rank test(P=0.933).In the subgroup analysis,the median survival time of the medical group and the surgical group were(53.9 vs 51.7 months),but the difference was not statistically significant by Log-rank test(P=0.875).Conclusion:The preferred treatment for elderly IMH is still medical treatment,and surgical treatment may improve the prognosis of elderly IMH-A.

关 键 词：急性主动脉综合征 主动脉壁间血肿 老年 内科治疗 手术治疗 

分 类 号：R543.1[医药卫生—心血管疾病]