主动脉夹层与高血压  

Aortic Dissection and Hypertension

作　　者：冯金华[1] 杨茂萍[1] 曹世平[1] 侯玉清[1] 

机构地区：[1]第一军医大学南方医院心内科,广东广州510515

出　　处：《高血压杂志》2003年第3期251-253,共3页Chinese Journal of Hypertension

摘　　要：目的　本研究主要探讨主动脉夹层 (AD)的发生与高血压 (HBP)的关系 ,伴有和不伴有HBP的AD患者临床特点及不同治疗措施对AD预后的影响。方法　资料来自 1992年 1月 - 2 0 0 2年 10月南方医院住院确诊的AD病人 5 3例 ,统计并分析其临床病史 ,首发症状 ,伴发和不伴发HBP患者的收缩压 ,舒张压和平均压的水平以及死亡情况 ,同时分析药物 ,手术和血管内支架三种不同治疗措施对预后的影响。结果　剧烈胸痛是大多数AD病人的第一症状 ,高血压患者AD的发生率 (4 1/ 5 3)明显高于非高血压患者 (12 / 5 3) (P <0 0 1) ,血压改变以收缩压和平均压的增高明显 (P<0 0 5和P <0 0 5 ) ,有高血压的AD患者早期死亡为 2 2 % ,晚期死亡率为 0 % ,而非高血压的AD病人早期死亡率为17% ,晚期死亡率为 12 % ;药物治疗组的有效率为 70 3% (2 6 / 37) ,死亡率 2 9 7% (11/ 37) ,手术治疗组有效率 4 4 4 %(4 / 9) ,治愈率 33 3% (3/ 9) ,死亡率 5 5 6 % (5 / 9) ;血管内支架治疗的治愈率 10 0 % (5 / 5 ) ,死亡率为 0 %。结论　主动脉夹层易发生在有HBP的患者 ,其发生的危险性与收缩压的关系比较密切 ,有HBP的AD患者早期死亡率高 ,而非HBP的AD患者死亡发生比较晚 ,HBP患者易发AD的机制可能与血管壁的“重塑” ,以及血管壁结缔?Objective To explore the relationship between development of aortic dissection (AD) and hypertension and the clinical characteristics of AD patients with and without hypertension.\ The effects of various managements on the prognosis of AD patients are also evaluated.\ Methods\ The data of 53 cases of AD were obtained from the hospitalized patients in Nanfang hospital between Jan 1992 to Oct 2002.\ The initial symptom, history, systolic, diastolic, average BP and mortality are collected.\ The effects of treatment with medical, surgical and intravascular-stent implantation of the prognosis were investigated.\ Results\ Severe chest pain is the first complaint of almost all patients with elevated SBP and mean BP.\ The mortality in AD patients with hypertension was 77.4% compared with 22.6% in patients without.\ The mortality in patients treated by medical therapy was 30%, by surgical treatment 67%, and by intravascular stent 0%.\ Conclusions\ SBP and mean BP are the main risk factors related to the occurrence of AD.\ AD patients with hypertension often died at the earlier stage after the onset of the diseases while patients with normotensive usually died lately.\ Although medical treatment is the primary and indispensable life saving measures in the management of AD, the intravascular stent implanting should be the first choice with the advantages of much safer and more effective.\ Surgery may be referred as a compensative measure to the management in complicated AD patients.

关 键 词：主动脉夹层 高血压 死亡率 

分 类 号：R544.1[医药卫生—心血管疾病]