急性Standford A型主动脉夹层合并肺动脉壁内血肿CT血管成像表现与预后  

CT angiography manifestations and prognosis of acute Standford type Aaortic dissection complicated with pulmonary arteryintramural hematoma

作　　者：周璐[1] 王姝文 刘豆豆 孙明华[1] 葛英辉[1,2] ZHOU Lu;WANG Shuwen;LIU Doudou;SUN Minghua;GE Yinghui(Department of Radiology,Fuwai Central Hospital of Zhengzhou University,Fuwai Central China Cardiovascular Hospital,Henan Provincial Key Laboratory of Cardiology Medical Imaging,Zhengzhou 451460,China;Department of Radiology,Henan Province People's Hospital,Zhengzhou 450003,China)

机构地区：[1]郑州大学华中阜外医院、阜外华中心血管病医院放射科、河南省心脏病影像医学重点实验室,河南郑州451460 [2]河南省人民医院放射科,河南郑州450003

出　　处：《中国医学影像技术》2024年第4期536-540,共5页Chinese Journal of Medical Imaging Technology

基　　金：河南省医学科技攻关省部共建项目(SB201901097)。

摘　　要：目的观察急性Standford A型主动脉夹层(AD)合并肺动脉壁内血肿(PAIH)CT血管成像(CTA)表现,分析其与预后的关系。方法回顾性分析55例急性Standford A型AD合并PAIH患者(PAIH组)及55例无PAIH的急性Standford A型AD患者(对照组)资料,对比2组主动脉及冠状动脉CTA表现,观察PAIH组术后15天血肿吸收情况,根据2组出院后1年内主动脉不良事件发生情况分析急性Standford A型AD患者预后的独立影响因素。结果PAIH组升主动脉最宽径大于对照组[(5.22±0.57)cm vs.(4.54±0.45)cm,t=6.963,P<0.001],主动脉瓣、窦管结合部、右冠窦、无冠窦及右冠状动脉更易受累,且更易出现心包积液和胸腔积液(P均<0.05)。PAIH组42例接受手术治疗,13例因病情危重未能接受手术治疗而死亡;术后15天其中36例血肿范围较前缩小。对103例完成随访,其中63例预后良好、40例预后不良。年龄及合并PAIH是急性Standford A型AD患者预后不良的独立影响因素(OR=1.07、4.71)。结论急性Standford A型AD合并PAIH的CTA表现具有一定特征性,有助于预测预后不良。Objective To investigate CT angiography(CTA)manifestations of acute Standford type A aortic dissection(AD)complicated with pulmonary artery intramural hematoma(PAIH),and to explore correlations with prognosis.Methods Data of 55 patients with acute Standford type A AD complicated with PAIH(PAIH group),as well as 55 acute Standford type A AD patients without PAIH(control group)were retrospectively analyzed.Aortal and coronary CTA manifestations groups were compared between groups,and hematoma absorption in PAIH group 15 days after treatment was observed.Aortic adverse events were also compared between groups within 1 year after discharge,and the patients were divided into those with good prognosis or with poor prognosis,the impact factors of prognosis were screened.Results The maximum width of ascending aorta in PAIH group was larger than that in control group([5.22±0.57]cm vs.[4.54±0.45]cm,t=6.963,P<0.001).PAIH was likely to involve aortic valve,sinus canal junction,right and noncoronary sinus and right coronary artery,and patients in PAIH group were likely to occur pericardial and pleural effusion(all P<0.05).In PAIH group,42 cases received surgical treatment,13 cases did not receive surgical treatment for critical condition and then died.Fifteen days after surgery,36 of 42 cases had reduced scope of hematoma.Totally 103 cases were followed up,63 were found with good prognosis while and 40 with poor prognosis.Age and complicated with PAIH were both independent predictors of poor prognosis in acute Standford type A AD patients(OR=1.07,4.71).Conclusion CTA manifestations of acute Standford type A AD complicated with PAIH had certain characteristics,which might be helpful for predicting prognosis.

关 键 词：主动脉夹层 肺动脉 血肿 CT血管成像 

分 类 号：R543.2[医药卫生—心血管疾病] R814.42[医药卫生—内科学]