床旁超声心动图在Stanford A型主动脉夹层中的应用价值  

Application Value of Bedside Echocardiography in Stanford Type A Aortic Dissection

作　　者：占晓洁 蒋媛媛[1] 黄小川[1] ZHAN Xiaojie;JIANG Yuanyuan;HUANG Xiaochuan(Department of Ultrasound Imaging,the First Affiliated Hospital of Xiamen University,Xiamen Fujian 361000,China)

机构地区：[1]厦门大学附属第一医院超声影像科,福建厦门361000

出　　处：《中国卫生标准管理》2024年第10期99-103,共5页China Health Standard Management

摘　　要：目的 探讨床旁超声心动图在StanfordA型主动脉夹层(aorticdissection,AD)诊断及预后评估中的价值。方法 以2021年7月—2023年6月厦门大学附属第一医院收治的80例临床诊断为StanfordA型AD的患者为研究对象。全部患者入院后均于床旁行经胸超声心动图(transthoracic echocardiography,TTE),回顾性调研患者临床资料,分析床旁TTE表现,评价床旁TTE诊断StanfordA型AD准确率。另外,对比观察床旁TTE检出的StanfordA型AD中发生院内死亡与生存患者的超声心动图表现,统计学分析床旁TTE表现与StanfordA型患者院内死亡的关系,评价床旁TTE评估患者预后的价值。结果 床旁TTE检出StanfordA型AD78例,漏诊2例,诊断准确率为97.50%。StanfordA型AD生存与死亡患者的心包积液率、左室射血分数(left ventricular ejection fraction,LVEF)<50%占比、主动脉窦部扩张率、主动脉总反流率比较,差异无统计学意义(P>0.05);死亡患者主动脉根部与升主动脉直径大于生存患者,主动脉瓣受累与重度主动脉瓣反流占比高于生存患者,差异有统计学意义(P<0.05)。经logisitc回归分析显示,主动脉根部直径、主动脉瓣受累、升主动脉直径、重度主动脉瓣反流4项是StanfordA型AD患者院内死亡独立影响因素。受试者工作特征(receiver operating characteristic,ROC)曲线分析结果显示,上述4项曲线下面积(area under the curve,AUC)均>0.7,可用于预测StanfordA型AD患者院内死亡且联合预测价值最高(AUC=0.815)。结论 床旁TTE诊断StanfordA型AD的准确率较高,可以为疾病临床急救提供依据,主动脉根部直径增大、主动脉瓣受累、升主动脉直径增大、重度主动脉瓣反流是StanfordA型AD院内死亡危险因素,以床旁TTE监测这些指标可以为评估患者预后提供有价值的参考,联合应用预测价值更高。Objective To explore the value of bedside echocardiography in the diagnosis and prognosis evaluation of Stanford type A aortic dissection(AD).Methods A total of 80 patients diagnosed with Stanford A type AD who were admitted to the First Affiliated Hospital of Xiamen University from July 2021 to June 2023 were selected as the study subjects.All patients underwent transthoracic echocardiography(TTE)at bedside after admission.Clinical data of the patients were retrospectively analyzed,and the accuracy of bedside TTE in diagnosing Stanford A type AD was evaluated.In addition,echocardiographic findings of patients with in-hospital death and survival in Stanford type A AD detected by TTE at bed were compared,and the relationship between TTE findings at bed and in-hospital death in Stanford type A patients was statistically analyzed,so as to evaluate the value of TTE at bed in evaluating patients'prognosis.Results A total of 78 cases of Stanford A type AD were detected by bedside TTE,and 2 cases were missed,with a diagnostic accuracy rate of 97.50%.There was no statistically significant difference in pericardial effusion rate,left ventricular ejection fraction(LVEF)<50%,aortic sinus dilation rate,and total aortic regurgitation rate between survival and death patients with Stanford type A AD(P>0.05).The diameter of the aortic root and ascending aorta in death patients was larger than that in survival patients,and the proportion of aortic valve involvement and severe aortic regurgitation was higher than that in survival patients,the difference was statistically significant(P<0.05).Logistic regression analysis showed that the diameter of the aortic root Aortic valve involvement,ascending aortic diameter,and severe aortic regurgitation are independent influencing factors for in-hospital mortality in Stanford A type AD patients.The analysis results of receiver operating characteristic(ROC)curve showed that the area under the curve(AUC)of the above four items were all>0.7.Predicted in-hospital death in Stanford type A AD pat

关 键 词：主动脉夹层 Stanford A型 床旁超声心动图 诊断 预后 临床效能 

分 类 号：R543[医药卫生—心血管疾病]