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主动脉夹层围术期高危因素的临床分析
CLINICAL ANALYSIS of RISK FACTORS for AORTIC DISSECTION
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DOI:
作者:
张伸
ZHANG Shen
作者单位:
上海市胸科医院
SHANGHAI CHEST HOSPITAL
关键词:
主动脉, 夹层动脉瘤, 预后,高危因素
aortic dissection, prognosis, risk factors
摘要:
目的:根据患者治疗情况回顾性分析导致患者围术期死亡的高危因素,总结经验为临床救治提供参考。 方法:收集2004年至2010年间心外科监护室收治的70例主动脉夹层患者。男性58例,女性12例;根据Stanford分型法,A型夹层37例, B型33例。单纯保守治疗17例,手术治疗29例,支架治疗24例。收集所有患者治疗前后的临床资料,对所收集的数据进行比较分析。 结果:手术组康复出院23例,死亡6例,死亡率20.7%。术后发生各类并发症19例,支架组顺利出院22例,死亡2例,死亡率8.3%,保守治疗组在治疗期间死亡6例,死亡率为35.3%。 结论:术前血流动力学不稳定或合并脑梗塞(P=0.001),瘤体直径大于5cm(P=0.01),A型夹层术后有两个或两个以上系统产生并发症(P=0.001)均为围术期死亡的高危因素。此外,对于B型夹层患者,因种种原因未及时行介入治疗(P=0.05)以及术后内漏(P=0.04)亦增加死亡风险。
Objective: The purpose of this retrospective study is to analyze the risk factors that might cause death in patients who had aortic dissection (AD) during hospitalization and discharge. Methods: A retrospective analysis was performed on 70 patients with AD. AD was classified into 2 types according to Stanford classification. There were 58 males and 12 females. Among them 37 were type A and 33 were type B. Surgery was performed in 29 patients. 24 patients had an interventional therapy with an intra-aortic stent and conservative treatment in 17 patients. Clinical data including patients’ demographics,type of AD, cardiac function grading, the methods for treatment, surgical procedures, medication used, image analysis, perioperative characteristics and hemodynamic parameters were recorded and analyzed. Follow up duration was 6 month to 5 years. Results: Six patients died after surgery, the mortality of this surgical group was 20.7%. Two patients died after endovascular stent grafting, one had cardiac arrest and another due to the rupture of the AD. The mortality of this group was 8.3%. In conservative group, 6 patients died during treatment, the mortality of this group was 35.3%. Conclusions: Aortic dissection is a severe surgical disease. Hemodynamic compromise (P=0.001), perioperative cerebral infarction (P=0.001) , diameter of dissecting aneurysm above 5cm(P=0.01) and multiple organ failure (MOF) after surgery (P=0.001) in type A aortic dissection were risk factors for death. As to Stanford B type, if interventional therapy was not performed in time for patients who had no obvious contraindications (P=0.05) and internal hemorrhage(P=0.04) also increased the risk of death.
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