中华医学杂志
中華醫學雜誌
중화의학잡지
National Medical Journal of China
2010年
42期
2994-2998
,共5页
沈洪%姚晨玲%陶振钢%奚百顺%栾骁%施东伟%孙湛%童朝阳%魏来%王春生
瀋洪%姚晨玲%陶振鋼%奚百順%欒驍%施東偉%孫湛%童朝暘%魏來%王春生
침홍%요신령%도진강%해백순%란효%시동위%손담%동조양%위래%왕춘생
主动脉疾病%手术期间%危险因素
主動脈疾病%手術期間%危險因素
주동맥질병%수술기간%위험인소
Aortic diseases%Intraoperative period%Risk factors
目的 探讨预测主动脉夹层围手术期死亡危险因素.方法 回顾性分析2003年1月至2008年6月复旦大学附属中山医院心外科主动脉夹层361例患者的病历资料,对患者转归进行单因素以及多因素回归分析.结果 单因素分析提示高血压病史(OR 0.465,95%CI 0.229-0.947,P=0.035),急性病程(OR 7.897,95% CI 1.874～33.275,P=0.005),Stanford A型(OR 2.758,95%CI1.054～7.213,P=0.039),神经系统症状阳性(OR 0.275,95% CI 0.140～0.541,P<0.001),手术与否(OR 8.206,95%CI 4.205～16.012,P<0.001)与转归相关,多因素回归分析提示急性病程(OR8.178,95% CI 1.796～37.242,P=0.007)、Stanford A型(OR 3.236,95% CI 1.104～9.487,P=0.032)、神经系统症状阳性(OR 0.350,95% CI 0.159～0.770,P=0.009)以及手术与否(OR 9.429,95% CI 4.456～19.952,P<0.001)对预后有重要影响.结论 高血压病史、急性病程、Stanford A分型、神经系统症状阳性是主动脉夹层围手术期死亡预测因素,手术与否是患者转归的决定性因素.
目的 探討預測主動脈夾層圍手術期死亡危險因素.方法 迴顧性分析2003年1月至2008年6月複旦大學附屬中山醫院心外科主動脈夾層361例患者的病歷資料,對患者轉歸進行單因素以及多因素迴歸分析.結果 單因素分析提示高血壓病史(OR 0.465,95%CI 0.229-0.947,P=0.035),急性病程(OR 7.897,95% CI 1.874～33.275,P=0.005),Stanford A型(OR 2.758,95%CI1.054～7.213,P=0.039),神經繫統癥狀暘性(OR 0.275,95% CI 0.140～0.541,P<0.001),手術與否(OR 8.206,95%CI 4.205～16.012,P<0.001)與轉歸相關,多因素迴歸分析提示急性病程(OR8.178,95% CI 1.796～37.242,P=0.007)、Stanford A型(OR 3.236,95% CI 1.104～9.487,P=0.032)、神經繫統癥狀暘性(OR 0.350,95% CI 0.159～0.770,P=0.009)以及手術與否(OR 9.429,95% CI 4.456～19.952,P<0.001)對預後有重要影響.結論 高血壓病史、急性病程、Stanford A分型、神經繫統癥狀暘性是主動脈夾層圍手術期死亡預測因素,手術與否是患者轉歸的決定性因素.
목적 탐토예측주동맥협층위수술기사망위험인소.방법 회고성분석2003년1월지2008년6월복단대학부속중산의원심외과주동맥협층361례환자적병력자료,대환자전귀진행단인소이급다인소회귀분석.결과 단인소분석제시고혈압병사(OR 0.465,95%CI 0.229-0.947,P=0.035),급성병정(OR 7.897,95% CI 1.874～33.275,P=0.005),Stanford A형(OR 2.758,95%CI1.054～7.213,P=0.039),신경계통증상양성(OR 0.275,95% CI 0.140～0.541,P<0.001),수술여부(OR 8.206,95%CI 4.205～16.012,P<0.001)여전귀상관,다인소회귀분석제시급성병정(OR8.178,95% CI 1.796～37.242,P=0.007)、Stanford A형(OR 3.236,95% CI 1.104～9.487,P=0.032)、신경계통증상양성(OR 0.350,95% CI 0.159～0.770,P=0.009)이급수술여부(OR 9.429,95% CI 4.456～19.952,P<0.001)대예후유중요영향.결론 고혈압병사、급성병정、Stanford A분형、신경계통증상양성시주동맥협층위수술기사망예측인소,수술여부시환자전귀적결정성인소.
Objective To analyze the peri-operative risk factors of mortality in patients with aortic dissection (AD). Methods Between January 2003 and June 2008, 361 AD patients at our hospital were enrolled. Their demographics, history, clinical characteristics and laboratory examinations were retrospectively analyzed. Twenty pre-operative variables were analyzed to identify the predictors of perioperative mortality of AD patients by the analyses of univariate and multivariate logistic regression.Results The analysis of univariate logistic regression showed that history of hypertension [odds ratio (OR)0.465, 95% confidence interval (CI) 0.229 -0.947, P = 0.035], Stanford type A (OR 2. 758,95% CI 1.054- 7.213 P = 0.039), acute course (OR 7. 897,95 % CI 1. 874-33. 275 P = 0.005), neurological symptoms (OR 0.275 ,95% CI 0.140 -0.541 ,P <0.001) and operation or not (OR 8. 206 ,95% CI 4.205 -16.012,P <0.001) had a higher mortality in AD patients. The multivariate analysis revealed that acute course (OR 8. 178 ,95% CI 1. 796-37. 242, P = 0.007), Stanford type A (OR 3. 236 ,95% CI 1.104-9.487 P = 0.032), neurological symptoms (OR 0.350 , 95% CI 0.159-0.770, P = 0.009) and operation or not (OR 9.429 ,95% CI 4. 456-19. 952 ,P <0.001) were significant independent predictors of perioperative mortality in AD patients. Conclusion History of hypertension, acute course, Stanford A and positive neurological symptoms are the independent predictors of perioperative mortality in AD patients.Operation or not is a determinant of patient outcome.
