急性A型主动脉夹层患者发病24小时内行保守治疗死亡的危险因素分析  

Risk factors for 24-hour death in acute type A aortic dissection patients with conservative treatment

作　　者：薛源[1,2] 张宏家 XUE Yuan;ZHANG Hongjia(Department of Cardiac Surgery,Beijing Anzhen Hospital,Capital Medical University,Beijing,100029,P.R.China;Department of Cardiac Surgery,Beijing Chaoyang Hospital,Capital Medical University,Beijing,100020,P.R.China)

机构地区：[1]首都医科大学附属北京安贞医院心脏外科,北京100029 [2]首都医科大学附属北京朝阳医院心脏外科,北京100020

出　　处：《中国胸心血管外科临床杂志》2021年第8期935-939,共5页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

基　　金：国家重点研发计划(2017YFC1308000);国家自然科学基金青年项目(81800404);首都卫生发展研科研专项项目(2018-4-2068);北京市医院管理局青年人才培养“青苗”计划(QML20180601);北京市优秀人才培养资助青年骨干个人项目(2017000021469G254);心血管疾病生物医学工程教育部重点实验室;心血管疾病精准医学北京实验室(PXM2019_014226_000023)。

摘　　要：目的探讨急性Stanford A型主动脉夹层(ATAAD)非手术治疗患者发病24 h内死亡的危险因素。方法 2009年1月至2018年1月,我院连续收治行保守治疗的ATAAD患者243例患者,其中男167例、女76例,平均年龄(53.0±12.0)岁。分析ATAAD患者发病24 h内死亡的危险因素。结果非手术治疗的ATAAD患者住院病死率为37.9%(93/243),其中13.6%(33/243)的患者在发病24 h内死亡。多因素logistic回归分析发现,左心室舒张末期内径[OR=0.45,95%CI(0.25,0.83),P<0.01]和主动脉瓣反流[OR=7.26,95%CI(1.67,31.53),P<0.01]为发病24 h内死亡的独立危险因素。结论左心室舒张末期内径和主动脉瓣反流是ATAAD患者发病24 h内死亡的独立危险因素。因此,强烈建议出现左心室舒张末期内径缩小和主动脉瓣反流临床表现的患者尽快接受外科手术治疗。Objective To explore the risk factors for 24-hour death in acute type A aortic dissection(ATAAD)patients with conservative treatment.Methods From January 2009 to January 2018,243 ATAAD patients who received non-surgical intervention were admitted in Beijing Anzhen Hospital,including 167 males and 76 females with an average age of 53.0±12.0 years.The risk factors for 24-hour mortality were analyzed.Results The total in-hospital mortality rate was 37.9%(93/243),and 13.6%(33/243)patients died within 24 hours of onset.We found that left ventricular end diastolic diameter[LVEDD,OR=0.45,95%CI(0.25,0.83),P<0.01]and aortic regurgitation[OR=7.26,95%CI(1.67,31.53),P<0.01]were independent risk factors for 24-hour death in patients with ATAAD.Conclusion In this study,LVEDD and aortic regurgitation are identified as independent risk factors for 24-hour mortality in ATAAD patients.Therefore,patients with aortic regurgitation and small LVEDD should be treated with sugery as soon as possible.

关 键 词：急性Stanford A型主动脉夹层 主动脉瓣反流 左心室舒张末期内径 危险因素 

分 类 号：R543.1[医药卫生—心血管疾病]