急性主动脉夹层死亡的危险因素探析.pdfVIP

摘 要 急性主动脉夹层死亡的危险因素分析 研究生：郝明辉 导师：买苏木·马合木提 副教授 摘 要 目的:分析急性主动脉夹层院内死亡的危险因素。方法:采用回顾性分析方法分析 2002~2009年资料完整的304例急性主动脉夹层病例,使用Logistic 回归分析年龄、性 别、病因、临床症状及体征、治疗方法的选择与急性主动脉夹层的临床病死率的关 系。结果: ① 304 例患者中( 男227 例, 女77 例) 男女性别之比为2.9:1 ，平均年龄 (54.31±14.24) 岁，②总体临床病死率为18.4 %。其中按Debakey分型, Debakey Ⅰ型患 者临床病死率为42.8% , Debakey Ⅱ型患者临床病死率8.70%,DebakeyⅢ型患者临床病 死率为4.37 % 。③ Logistic 回归分析示:主动脉瓣返流(P = 0.005,OR=4.450) 、急性肾 功能不全或一过性肌酐升高(P=0.022, OR=3.282) 、心包积液或心包填塞(P= 0.004,OR=3.957) 、局部肢体缺血(任一肢体) (P = 0.001,OR=4.267) 、Debakey Ⅰ型(P = 0.000, OR=5.449)、药物保守治疗(P = 0.001,OR=4.721) ，为急性主动脉夹层预测死亡 的危险因素。结论:主动脉瓣返流、急性肾功能不全或一过性肌酐升高、急性心包填 塞或心包积液、局部肢体缺血、分型为Debakey Ⅰ型、治疗选择药物保守治疗为急性 主动脉夹层的独立死亡危险因素。 关键词：急性主动脉夹层；病死率；危险因素 —1— 新疆医科大学医学硕士学位论文 Risk Factor Analysis for Intrahospital Death of Acute Phase of Aortic Dissection Postgratude : Hao Ming-hui Supervisor: Prof. Mai Su-mu Abstract Objective: To analyze the risk factor for intrahospital eath of acute aortic dissection(AD). Methods: Clinical data of 304 patients with AD in the First Affiliated Hospital Xinjiang Medical University fron 2002 to 2009 were analyzed retrospectively. Results: Among 304 cases with AD, the male/female ratio was 2.9:1, the mean age was (54.31±14.24). The intrahospital mortality was 18.4 % in overall patients, the intrahospital mortality of the debakey Ⅰpatients was 42.8%;the Debakey Ⅱ was 8.70%; the DebakeyⅢ was 4.37%. The regression analysis show that aortic regurgitation (p=0.005 OR=4.450), acute kidney failure (p=0.022, OR=3.282), hydropericardium or cardiac tamponade (p=0.004,OR=3.957), local Limbs ischemi