急性Stanford A型主动脉夹层术前死亡的危险因素分析  

Analysis of risk factors for preoperative mortality of acute Stanford type A aortic dissection

作　　者：李晓南[1] 乔环宇[1] 杨波[1] 赵宏磊 薛金熔[1] 白涛[1] 孙立忠[1] 刘永民[1] LI Xiaonan;QIAO Huanyu;YANG Bo;ZHAO Honglei;XUE Jinrong;BAI Tao;SUN Lizhong;LIU Yongmin(Depart-ment of Cardiovascular Surgery,Beijing Anzhen Hospital,Capital Medical University,Beijing Institute of Heart,Lung and Blood Vessel Diseases,Beijing 100029,China)

机构地区：[1]首都医科大学附属北京安贞医院-北京市心肺血管疾病研究所北京大血管疾病诊疗中心心脏外科,100029

出　　处：《心肺血管病杂志》2020年第10期1225-1229,共5页Journal of Cardiovascular and Pulmonary Diseases

基　　金：北京市科学技术委员会(Z19110700660000)。

摘　　要：目的:探究急性Stanford A型主动脉夹层(ATAAD)术前死亡的预测危险因素,以更加准确、及时的识别ATAAD危重症患者,从而提高主动脉夹层的救治率,挽救更多患者的生命。方法:回顾性分析2014年9月至2016年12月,首都医科大学附属北京安贞医院大血管疾病诊疗中心,收治的120例ATAAD患者的临床资料,根据患者术前是否发生死亡,将患者分为术前死亡组(15例)和未死亡组(105例)。通过应用Logistic回归联合ROC曲线等方法对患者术前死亡的危险因素进行筛选和分析。结果:通过比两组患者的临床特征发现,死亡组患者合并腹腔脏器缺血发生率更高、近远端破口面积比值更大。进一步通过多因素Logistic回归和ROC曲线分析表明,近远端破口面积比值>1.63是ATAAD患者术前死亡的预测危险因素(OR=11.366,95%CI:1.156~111.752,ROC曲线下面积为0.826,Cut-off值1.63,敏感性86.7%,特异性79.0%,约登指数0.657)。同时该研究结果表明,与近端破口面积、远端破口面积等单一指标相比,联合近远端破口面积之比对高危ATAAD患者的预测价值更高。结论:本研究结果表明,近远端破口面积比值>1.63是ATAAD患者术前死亡的预测危险因素。在Stanford A型主动脉夹层的临床诊疗工作中,近远端破口面积比值在判断ATAAD患者的病情危重程度、尽快且准确识别高危患者以争取手术时机具有重要的临床指导和实践意义。Objective: To explore the independent predictors of preoperative mortality of acute Stanford type A aortic dissection(ATAAD) and to identify the severe ATAAD patients more accurately and timely, so as to increase the cure rate of aortic dissection. Methods: The clinical data of 120 patients with ATAAD from September 2014 to December 2016 in Beijing Anzhen Hospital Affiliated to Capital Medical University were analyzed retrospectively. The patients were divided into preoperative death group(n=15) and non-death group(n=105). The risk factors of preoperative death were screened and analyzed by Logistic regression and ROC curve. Results: It was found that the incidence of abdominal organ ischemia and the proximal and distal tear size ratio in the death group was higher significantly that those in the non-death group. The multivariate Logistic regression showed that proximal and distal tear size ratio>1.63 was the independent risk factor of preoperative death in ATAAD patients(OR=11.366,95%CI:1.156-111.752;P=0.037). The area under the ROC curve was 0.826 and cut-off value was 1.63(sensitivity:86.7%, specificity:79%, Youden index: 0.657). Conclusions: Proximal and distal tear size ratio>1.63 was the independent risk factor of preoperative death in ATAAD patients. It has important clinical guidance and practical significance in determining the critical degree of ATAAD patients, thus to identify high-risk patients as soon as possible and to strive for the opportunity of surgery.

关 键 词：急性Stanford A型主动脉夹层 危险因素 破口面积 

分 类 号：R54[医药卫生—心血管疾病]