急救室主动脉夹层患者院内死亡的独立预测因子  

Independent predictors of in-hospital mortality in patients with aortic dissection in the emergency room

作　　者：冷巧云[1] 陈细细 程丽娜 刘汉 LENG Qiaoyun;CHEN Xixi;CHENG Lina;LIU Han(Department of Emergency,Jiujiang NO.1 Peoples Hospital,Jiujiang,Jiangxi,332000,China)

机构地区：[1]九江市第一人民医院急诊科,江西九江332000

出　　处：《临床急诊杂志》2022年第6期437-442,共6页Journal of Clinical Emergency

摘　　要：目的:探讨急诊抢救室主动脉夹层(AD)患者院内死亡的独立预测因子。方法:回顾性纳入2014年1月1日-2020年12月31日期间我院急救室接诊的AD患者临床资料,联合logistic回归分析及ROC分析影响其院内死亡的相关因素,并研究其预测效能。结果:纳入273例AD患者,其中院内死亡87例,院内病死率为31.9%。Logistic回归分析结果显示入院收缩压水平<140 mmHg(OR=5.570,P<0.01,95%CI:2.534~12.242)、D-二聚体水平≥4.5μg/mL(OR=4.870,P<0.01,95%CI:2.244~10.573)、Stanford分型A型(OR=4.115,P=0.001,95%CI:1.844~9.183)、未实施胸痛中心管理模式(OR=3.454,P=0.002,95%CI:1.570~7.598)、药物保守治疗(OR=8.895,P<0.01,95%CI:4.131~19.156)是主动脉夹层患者院内死亡的独立预测因子。结论:急诊抢救室AD患者入院时收缩压<140 mmHg或D-二聚体水平≥4.5μg/mL或Stanford分型为A型的院内死亡风险更高,建议采取胸痛中心管理模式对此类患者进行诊疗并尽快实施介入或手术治疗。Objective:The present study explored the independent predicting factors for the in-hospital deaths in patients with aortic dissection(AD)in the emergency room.Methods:The clinical data from AD patients treated in the emergency room from January 1,2014 to December 31,2020 were retrospectively registered.The related factors that could influence in-hospital death were analyzed by logistic regression analyses and ROC analyses,and the prediction efficiency was studied.Results:Among 273 enrolled patients with AD,87 patients died in the hospital with a mortality rate of 31.9%.Logistic regression results showed that the systolic blood pressure at admission<140 mmHg(OR=5.570,P<0.01,95%CI:2.534-12.242),D-dimer level≥4.5μg/mL(OR=4.870,P<0.01,95%CI:2.244-10.573),Stanford type A(OR=4.115,P=0.001,95%CI:1.844-9.183),not applying the chest pain center(CPC)management mode(OR=3.454,P=0.002,95%CI:1.570-7.598),and conservative drug therapy(OR=8.895,P<0.01,95%CI:4.131-19.156)were independent predicting factors for in-hospital death in AD patients.Conclusion:Patients with AD in the emergency room with systolic blood pressure<140 mmHg,Stanford type A,or D-dimer level≥4.5μg/mL have a higher risk of in-hospital death.It is recommended to adopt the chest pain center management mode for diagnosis and treatment of such patients and implement interventional or surgical treatment as soon as possible.

关 键 词：主动脉夹层 院内死亡 预测因子 LOGISTIC回归分析 急救室 

分 类 号：R543.1[医药卫生—心血管疾病]