急性Stanford A型主动脉夹层术前危险因素的多中心回顾性队列研究  

Preoperative risk factors for the onset of acute Stanford type A aortic dissection in a multicenter study:A retrospective cohort study

作　　者：武玉多 贡鸣[1] 孙立忠[1] 黄连军[1] 刘永民[1] 朱俊明[1] 谷天祥[2] 范瑞新[3] 钱希明[4] 张宏家[1] WU Yuduo;GONG Ming;SUN Lizhong;HUANG Lianjun;LIU Yongmin;ZHU Junming;GU Tianxiang;FAN Ruixin;QIAN Ximing;ZHANG Hongjia(Department of Cardiac Surgery,Beijing Anzhen Hospital,Capital Medical University,Beijing Vascular Disease Diagnosis and Treatment Center,Beijing,100029,P.R.China;Department of Cardiac Surgery,The First Affiliated Hospital of China Medical University,Shenyang,110001,P.R.China;Department of Cardiac Surgery,Guangdong Provincial Institute of Cardiovascular Diseases,Guangzhou,510080,P.R.China;Department of Cardiac Surgery,Sir Run Run Shaw Hospital,Zhejiang University School of Medicine,Hangzhou,310000,P.R.China)

机构地区：[1]首都医科大学附属北京安贞医院北京大血管疾病诊疗中心心脏外科,北京100029 [2]中国医科大学附属第一医院心脏外科,沈阳110001 [3]广东省心血管病研究所心脏外科,广州510080 [4]浙江大学医学院附属邵逸夫医院心脏外科,杭州310000

出　　处：《中国胸心血管外科临床杂志》2022年第8期986-991,共6页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

基　　金：国家重点研发计划(2018YFC1002300);心血管疾病精准医学北京实验室项目(PXM2018_014226_000013)。

摘　　要：目的评估我国急性Stanford A型主动脉夹层(acute Stanford type A aortic dissection,ASTAAD)患者的术前危险因素。方法连续纳入2018年1月—2020年1月间多中心数据库中700例因ASTAAD行手术治疗的患者。根据升主动脉大小(ascending aorta size,AAS),将患者分为AAS≥55 mm组和AAS<55 mm组两组。使用单因素和多因素logistic回归分析对影响ASTAAD出现的相关术前危险因素进行分析。结果根据排除标准,最后入组患者共有621例,其中男453例、女168例,平均年龄(48.24±11.51)岁。509例(81.94%)ASTAAD患者的AAS<55 mm。单因素和多因素分析显示:吸烟、高血压、术前心脏肌钙蛋白I和左室射血分数与ASTAAD发生相关。患者住院期间死亡率为13.04%(81例)。结论影响ASTAAD患者的术前危险因素多样,在临床实践中,应多方面关注影响患者预后的各种因素,对患者进行综合评判及个体化分析,并及时进行预防和干预,以提高患者的生存率。Objective To evaluate the preoperative risk factors for acute Stanford type A aortic dissection(ASTAAD)patients in our country by collecting multi-center data.Methods We consecutively enrolled 700 patients who underwent surgery for ASTAAD in the multi-center hospital database from January 2018 to January 2020.According to the ascending aorta size(AAS),the patients were divided into two groups:a group AAS≥55 mm and a group AAS<55 mm.Univariate and multivariate logistic regression analyses were used to investigate the related preoperative risk factors for the onset of ASTAAD.Results According to the exclusion criteria,a total of 621 patients were finally enrolled,including 453 males and 168 females with an average age of 48.24±11.51 years,and 509(81.94%)patients had AAS<55 mm.Univariate and multivariate statistical analyses showed that smoking,hypertension,preoperative cardiac troponin I,and left ventricular ejection fraction were related to the occurrence of ASTAAD.The mortality rate of the patient during hospitalization was 13.04%(81 patients).Conclusion In clinical practice,various preoperative risk factors affect ASTAAD patients,which should be paid attention to.Comprehensive evaluation and an individualized analysis of patients and timely prevention and intervention improve patients'survival rate.

关 键 词：急性Stanford A型主动脉夹层 危险因素 多中心研究 

分 类 号：R654.3[医药卫生—外科学]