急性主动脉综合征强化保守治疗临床疗效研究  

Clinical efficacy of intensive conservative treatment for acute aortic syndrome

作　　者：朱尹凡 戴路 吴昊天 李雅敏[2] 李东杰 王世攀 梁嘉俊 严研[3] 皋健钧 楼烨挺 陶震泽 鲁亦凡 杨智然 李嘉[1] 陈思吉 刘创 张亚哲 米玉红[2] 李海洋[1] 姜文剑[1] 张宏家[1] Zhu Yinfan;Dai Lu;Wu Haotian;Li Yamin;Li Dongjie;Wang Shipan;Liang Jiajun;Yan Yan;Gao Jianjun;Lou Yeting;Tao Zhenze;Lu Yifan;Yang Zhiran;Li Jia;Chen Siji;Liu Chuang;Zhang Yazhe;Mi Yuhong;Li Haiyang;Jiang Wenjian;Zhang Hongjia(Department of Cardiac Surgery Center,Beijing Anzhen Hospital,Capital Medical University,Beijing 100029,China;Department of Emergency Intensive Care Unit,Beijing Anzhen Hospital,Capital Medical University,Beijing 100029,China;Center for Coronary Artery Disease,Beijing Anzhen Hospital,Capital Medical University,Beijing 100029,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安贞医院急诊危重症中心,北京100029 [3]首都医科大学附属北京安贞医院冠状动脉疾病中心,北京100029

出　　处：《中华胸心血管外科杂志》2025年第3期143-150,共8页Chinese Journal of Thoracic and Cardiovascular Surgery

基　　金：国家自然科学基金项目(82241205,82422007,82170487,82400548);北京市自然科学基金(JQ24039)。

摘　　要：目的前瞻性观察研究评价强化保守治疗比常规保守治疗对急性主动脉综合征患者临床预后的影响。方法前瞻性连续纳入2024年1月至2024年12月就诊于首都医科大学附属北京安贞医院、北京大望路急诊抢救医院的急性主动脉综合征患者,无法接受急诊手术或拒绝手术,行保守治疗。共纳入282例,排除数据缺失和未接受任何治疗死亡患者15例,最终纳入267例,其中94例强化保守治疗,173例常规保守治疗。通过逆概率加权校正基线数据,比较校正前后14、30天及随访结束时两组患者生存情况。结果校正混杂因素后,就诊后14天强化保守治疗的急性主动脉综合征患者生存率显著高于常规保守治疗的患者(82.40%对53.20%,P<0.0001),30天和276天中期随访时强化保守治疗患者生存率仍然显著高于常规保守治疗组(79.60%对51.60%,P<0.0001;78.50%对48.50%,P<0.0001)。在亚组分析中,与常规保守治疗组相比,A型主动脉夹层14、30和276天强化保守治疗组均有更高的生存率(63.46%对41.35%,P<0.05;52.17%对37.90%,P<0.05;50.00%对31.97%,P<0.05),B型主动脉夹层虽强化保守治疗生存率亦高于常规保守治疗,但差异无统计学意义(96.29%对80.00%,P=0.054;95.65%对78.37%,P=0.067;94.12%对74.20%,P=0.088)。结论确诊为急性主动脉综合征的患者,若无法第一时间行急诊手术而选择保守治疗时,强化保守治疗策略比常规保守治疗能显著降低急性期死亡比例。中期随访强化保守治疗仍具有显著生存优势。ObjectiveTo evaluate the outcomes of intensive conservative treatment compared to conventional conservative treatment in patients with acute aortic syndrome(AAS).MethodsThe study prospectively enrolled consecutive patients with AAS who were admitted to Beijing Anzhen Hospital,affiliated with Capital Medical University,and Beijing Dawanglu Emergency Rescue Hospital from January 2024 to December 2024.These patients with surgical contraindications or refused surgery for various reasons opted for conservative treatment.A total of 282 patients were included,and 15 patients with missing data or those who died without any treatment were excluded.Finally,267 patients were enrolled,of whom 94 received intensive conservative treatment,and 173 received conventional conservative treatment,the inverse probability of treatment weighting(IPTW)was used to reduce the influence of confoundings.After adjusting of baseline datas via IPTW,the survival outcomes of the two groups were compared at 14 days,30 days,and at the end of follow-up.ResultsThe results showed significant differences in acute phase survival rates between the enhanced conservative treatment group and the conventional conservative treatment group at 14 days(82.40%vs.53.20%,P<0.0001).Significant survival differences were also observed at 30 days and at 276-day mid-term follow-up(96.29%vs.51.60%,P<0.0001;78.50%vs.48.50%,P<0.0001).In the subgroup analysis,for type A aortic dissection,the enhanced conservative treatment group had higher survival rates compared to the conventional conservative treatment group at 14,30 and 276 days(63.46%vs.41.35%,P<0.05;52.17%vs.37.90%,P<0.05;50.00%vs.31.97%,P<0.05).However,for type B aortic dissection,although the enhanced conservative treatment group had higher survival rates than the conventional conservative treatment group,no statistically significant differences were observed(96.29%vs.80.00%,P=0.054;95.65%vs.78.37%,P=0.067;94.12%vs.74.20%,P=0.088).ConclusionFor patients diagnosed with AAS are forced to choose conservative treatment

关 键 词：急性主动脉综合征 主动脉夹层 强化保守治疗 

分 类 号：R543.1[医药卫生—心血管疾病]