影响夹层动脉瘤愈后因素的临床分析.DOC

PAGE 作者单位：上海市胸科医院重症监护室，上海，200030尊敬的编辑部： 根据初审意见，本文于数据收集和研究方法中加入了选择手术或保守或支架治疗的指征，由于本研究为临床回顾性研究，患者入院前后CT或心脏彩超检查即明确了夹层动脉瘤的分型，因此很难做到前瞻性随机分组主动脉夹层围术期高危因素的临床分析 张伸，杨敏，张海，李俊，郑知非 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。关键词: 主动脉, 夹层动脉瘤, 预后，高危因素CLINICAL ANALYSIS of RISK FACTORS for AORTIC DISSECTION ZHANG Shen，YANG Min，ZHANG Hai，LI Jun，ZHEN ZhifeiObjective: 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