65岁以上急性主动脉壁内血肿患者临床特点及治疗  

Clinical Features and Treatments of Acute Intramural Aortic Hematomas in Patients over 65 Years

作　　者：向军[1] 何玲[2] 李东林 魏蜀亮[1] 彭泰峦[1] 彭慧[1] XIANG Jun;HE Ling;LI Donglin;WEI Shuliang;PENG Tailuan;PENG Hui(Department of Cardiac Macrovascular Surgery,Affiliated Hospital of North Sichuan Medical College,Nanchong 637000,Sichuan,China;Department of Paediatrics,Affiliated Hospital of North Sichuan Medical College,Nanchong 637000,Sichuan,China)

机构地区：[1]川北医学院附属医院心脏大血管外科,四川南充637000 [2]川北医学院附属医院儿科,四川南充637000

出　　处：《心血管病学进展》2021年第2期183-187,共5页Advances in Cardiovascular Diseases

基　　金：川北医学院校级科研发展项目(CBY16-A-YB20)。

摘　　要：目的总结65岁以上老年患者主动脉壁内血肿(IMH)的临床特点并探讨治疗方案的选择,以期为临床诊治提供参考。方法回顾性分析2011年1月—2018年12月川北医学院附属医院收治的63例65岁以上老年IMH患者的临床资料,所有患者术前均行胸腹部计算机体层血管成像以明确诊断。其中24例患者仅接受单纯药物治疗(保守治疗组),39例患者接受药物治疗同时行手术治疗(手术治疗组)。收集两组患者的一般资料及治疗经过,分析两组患者不同治疗方案的预后。根据数据类型,分别选用卡方检验、t检验。结果63例患者中男性44例,女性19例,发病率以冬、春季节高,共46例(73%);保守治疗组年龄>手术治疗组[(74.14±6.55)岁vs(68.28±8.62)岁];手术治疗组患者3级高血压比例、合并溃疡样突起或穿透性溃疡比例及合并心包或胸腔积液比例明显高于保守治疗组(47.6%vs 12.7%,52.4%vs 19.5%,39.7%vs 6.4%,P<0.05);两组性别、发病季节、诊断时长、临床表现、血肿累及范围比较,差异无统计学意义(P>0.05);60例获得随访,随访率95.2%,手术治疗组患者症状缓解率及血肿吸收率明显高于保守治疗组(97.4%vs 70.8%,92.3%vs 66.7%,P<0.05);手术治疗组主动脉夹层发生率明显低于保守治疗组(0.0%vs 16.7%,P<0.05);两组并发症发生率及死亡率差异无统计学意义(P>0.05);虽然保守治疗组再次手术干预率高于手术治疗组(12.5%vs 2.6%),但差异无统计学意义(P>0.05)。结论65岁以上老年IMH多见于男性,其中又以Stanford B型多见,冬春季节好发;对于单纯型老年IMH,可选择保守治疗;对于合并溃疡样突起或穿透性溃疡及心包或胸腔积液的复杂型老年IMH,手术治疗效果优于保守治疗,但应尽量避免创伤较大的手术,杂交手术及胸主动脉腔内修复是目前治疗老年IMH的主要的手术方式。Objective To summarize clinical characteristics and explore therapeutic options of intramural aortic hematoma(IMH)in elderly patients over 65 years in hope of providing reference on clinical diagnosis and treatment.Methods Clinical data of 63 elderly patients over 65 years with IMH admitted in Affiliated Hospital of North Sichuan Medical College from Jan 2011 to Dec 2018 were analyzed retrospectively.All the patients were diagnosed by computed tomography angiography of thoracoabdominal aorta before surgery,24 of whom were only treated with medications(conservative treatment group,CT group)and the other 39 both received surgeries and medications(surgical treatment group,ST group).General data and therapeutic processes were collected,and prognosis of patients with different therapeutic options were analyzed.Chi-square test and t-test were selected for statistic analysis based on data type.Results 63 patients consist of 44 males and 19 females.Morbidity of IMH was high in winter and spring,accounting for 73 percents(46 cases).With mean age of CT group higher than ST group[(74.14±6.55)years vs(68.28±8.62)years],proportions of grade 3 hypertension and complicated with ulcer-like protrusions(ULP)or penetrating aortic ulcer(PAU),hydropericardium or hydrothorax in ST group were significantly higher than CT group(47.6%vs 12.7%,52.4%vs 19.5%,39.7%vs 6.4%,respectively).There exist no significant differences in gender,onset season,diagnostic duration,clinical manifestation and hematomas scope between two groups(P>0.05).60 cases were followed-up with the follow-up rate of 95.2 percents.Compared to CT group,rates of symptoms relief and hematomas absorption in ST group were significantly higher(97.4%vs 70.8%,92.3%vs 66.7%,P<0.05)concurrent with a decreased incidence of aortic dissection(AD)(0.0%vs 16.7%,P<0.05).Incidence of complications and mortality between two groups were statistically insignificant(P>0.05).The re-operation rate was slightly greater in CT group than ST group,yet without a significant difference(12.5%vs 2.6

关 键 词：老年人 主动脉壁内血肿 胸主动脉腔内修复术 临床特点 

分 类 号：R543.1[医药卫生—心血管疾病]