270例急性主动脉夹层患者临床特点和院内死亡危险因素分析

发布时间：2018-04-23 00:33

本文选题：急性主动脉夹层 + 临床特点　；参考：《安徽医科大学》2017年硕士论文

【摘要】：目的研究分析急性主动脉夹层患者的临床特点和院内死亡的危险因素。方法回顾性分析2013年1月至2015年12月住院的270例急性主动脉夹层患者的总体临床资料,包括发病时间、发病年龄、性别、既往史、主诉、生命体征、实验室检查、住院期间并发症、院内死亡率;比较Stanford A型和Stanford B型急性主动脉夹层患者临床资料;根据患者出院情况分为死亡组和存活组,分析急性主动脉夹层患者院内死亡危险因素,并进一步分析其院内死亡的独立危险因素。结果1.急性主动脉夹层患者平均发病年龄55.7±12.7岁,男女比例3.03:1,合并高血压病201例(74.4%),马凡综合征5例(1.9%),吸烟史77例(28.5%),有疼痛表现235例(87.0%),入院时收缩压、白细胞计数、D-二聚体水平高于正常,并发肾功能不全45例(16.7%),心包积液48例(17.8%),主动脉瓣关闭不全49例(18.1%),院内死亡44例(16.3%)。2.急性主动脉夹层好发于冬春季节,两型急性主动脉夹层均高发于1月、11月、12月。Stanford A型和Stanford B型急性主动脉夹层好发年龄均在40-69岁,Stanford B型急性主动脉夹层在高龄(年龄70岁)患者中仍占有较大比例。3.Stanford A型较Stanford B型急性主动脉夹层患者平均发病年龄小,入院时收缩压、舒张压水平较低,D-二聚体水平较高,并发肾功能不全、心包积液、主动脉瓣关闭不全比例高,院内死亡比例较高,差异均有统计学意义(P0.05)。4.与存活组比较,死亡组患者入院时收缩压、舒张压水平较低,D-二聚体水平较高,Stanford A型比例较高,并发肾功能不全、心包积液比例较高,差异均有统计学意义(P0.05)。进一步多因素Logistic回归分析,结果示入院时收缩压水平偏低,D-二聚体水平偏高,Stanford A型,并发肾功能不全、心包积液是急性主动脉夹层患者院内死亡的独立危险因素。结论1.急性主动脉夹层好发于冬春季节,常见于中老年男性。急性主动脉夹层患者常合并高血压、吸烟史,临床多表现为疼痛,入院时收缩压水平、白细胞计数、D-二聚体水平较高,并发症比例较高,院内死亡率较高。2.Stanford A型急性主动脉夹层患者较Stanford B型平均发病年龄小,入院时血压水平低,D-二聚体水平高,易合并并发症及出现院内死亡。3.入院时收缩压水平偏低、D-二聚体水平偏高、Stanford A型、并发肾功能不全、心包积液是急性主动脉夹层患者院内死亡的独立危险因素,临床应予以重视。
[Abstract]:Objective to study the clinical features and risk factors of hospital death in patients with acute aortic dissection. Methods the total clinical data of 270 patients with acute aortic dissection from January 2013 to December 2015 were retrospectively analyzed, including onset time, age, sex, past history, main complaint, vital signs, laboratory examination. Complications during hospitalization, hospital mortality, comparison of clinical data of patients with acute aortic dissection of Stanford A and Stanford B, and analysis of the risk factors of hospital death in patients with acute aortic dissection, according to the discharge status of the patients, the patients were divided into death group and survival group. The independent risk factors of hospital death were further analyzed. Result 1. The mean age of onset of acute aortic dissection was 55.7 卤12.7 years, the ratio of male and female was 3.03: 1, the incidence of hypertension was 74.4% in 201 cases, the incidence of Marfan's syndrome was 1.9%, the history of smoking was 28.55.235 cases had pain, the systolic blood pressure (SBP) and white blood cell count (Ddimer) were higher than normal. There were 45 cases of renal insufficiency, 48 cases of pericardial effusion, 49 cases of aortic valve insufficiency, 49 cases of aortic valve insufficiency and 44 cases of nosocomial death. Acute aortic dissection occurs in winter and spring. Both types of acute aortic dissection had a high incidence in January, November, December, 12. Stanford A and Stanford B acute aortic dissection in 40-69 years old and Stanford B acute aortic dissection still accounted for a large proportion of elderly patients (age 70). The average age of onset of Stanford A was younger than that of Stanford B acute aortic dissection. On admission, systolic blood pressure, diastolic blood pressure, renal insufficiency, pericardial effusion, aortic valve insufficiency and hospital mortality were higher, and the difference was statistically significant. Compared with the survival group, the systolic blood pressure and diastolic blood pressure in the death group were lower than those in the control group. The ratio of D-dimer, renal insufficiency and pericardial effusion were higher than those in the survival group, and the difference was statistically significant (P 0.05). Further multivariate Logistic regression analysis showed that low systolic blood pressure (SBP) and high D-dimer level were associated with renal dysfunction and pericardial effusion was an independent risk factor for hospital death in patients with acute aortic dissection. Conclusion 1. Acute aortic dissection usually occurs in winter and spring and is common in middle-aged men. Patients with acute aortic dissection often had high blood pressure, smoking history, pain, systolic blood pressure, white blood cell count and D-dimer, and high incidence of complications. The mortality in hospital was higher. 2. The average age of onset of acute aortic dissection of type A was lower than that of type B of Stanford. The blood pressure at admission was lower and the level of D-dimer was higher than that of patients with acute aortic dissection of type A. it was easy to be complicated with complications and death in hospital. Low systolic blood pressure (SBP) and high level of D-dimer were associated with renal insufficiency. Pericardial effusion was an independent risk factor for hospital death in patients with acute aortic dissection.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R543.1

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