华中科技大学学报（医学版）
華中科技大學學報（醫學版）
화중과기대학학보（의학판）
ACTA UNIVERSITATIS MEDICINAE TONGJI
2014年
6期
697-700
,共4页
刘曌宇%柴博兰%邹远林%曾和松
劉曌宇%柴博蘭%鄒遠林%曾和鬆
류조우%시박란%추원림%증화송
主动脉夹层%临床特征%死亡因素%Logistic回归分析
主動脈夾層%臨床特徵%死亡因素%Logistic迴歸分析
주동맥협층%림상특정%사망인소%Logistic회귀분석
aortic dissection%clinical feature%death factor%Logistic regression analysis
目的：探讨影响主动脉夹层患者院内死亡的相关因素。方法回顾性分析482例主动脉夹层患者的临床资料，对部分相关因素进行单因素及多因素Logistic回归分析。结果主动脉夹层发病平均年龄为（54.17±11.94）岁，男女比例为3.63：1.00；临床主要以疼痛为首发症状（447例，92.74％），疼痛的部位多位于胸部和背部。Stanford A型患者胸部疼痛发生率高于Stanford B型患者，腹部疼痛发生率则低于 Stanford B型患者，差异均有统计学意义（均 P＜0.05）。Stanford A型患者意识障碍和心包积液的发生率明显高于Stanford B型患者（P＜0.05）。482例患者院内死亡49例，病死率为10.17％。Logistic回归分析提示，Stanford A型（OR＝2.256，P＝0.025）和并发意识障碍（OR＝4.067， P＝0.009）是主动脉夹层患者死亡的独立危险因素，入院舒张压水平偏高（OR＝0.968，P＜0.01）和手术或介入治疗（OR＝0.170，P＝0.001）是主动脉夹层的保护因素。结论主动脉夹层以疼痛为主要表现，Stanford A型、并发意识障碍是导致住院死亡的独立危险因素，舒张压水平偏高为保护因素，手术或支架治疗是降低死亡率较安全和有效的方法。
目的：探討影響主動脈夾層患者院內死亡的相關因素。方法迴顧性分析482例主動脈夾層患者的臨床資料，對部分相關因素進行單因素及多因素Logistic迴歸分析。結果主動脈夾層髮病平均年齡為（54.17±11.94）歲，男女比例為3.63：1.00；臨床主要以疼痛為首髮癥狀（447例，92.74％），疼痛的部位多位于胸部和揹部。Stanford A型患者胸部疼痛髮生率高于Stanford B型患者，腹部疼痛髮生率則低于 Stanford B型患者，差異均有統計學意義（均 P＜0.05）。Stanford A型患者意識障礙和心包積液的髮生率明顯高于Stanford B型患者（P＜0.05）。482例患者院內死亡49例，病死率為10.17％。Logistic迴歸分析提示，Stanford A型（OR＝2.256，P＝0.025）和併髮意識障礙（OR＝4.067， P＝0.009）是主動脈夾層患者死亡的獨立危險因素，入院舒張壓水平偏高（OR＝0.968，P＜0.01）和手術或介入治療（OR＝0.170，P＝0.001）是主動脈夾層的保護因素。結論主動脈夾層以疼痛為主要錶現，Stanford A型、併髮意識障礙是導緻住院死亡的獨立危險因素，舒張壓水平偏高為保護因素，手術或支架治療是降低死亡率較安全和有效的方法。
목적：탐토영향주동맥협층환자원내사망적상관인소。방법회고성분석482례주동맥협층환자적림상자료，대부분상관인소진행단인소급다인소Logistic회귀분석。결과주동맥협층발병평균년령위（54.17±11.94）세，남녀비례위3.63：1.00；림상주요이동통위수발증상（447례，92.74％），동통적부위다위우흉부화배부。Stanford A형환자흉부동통발생솔고우Stanford B형환자，복부동통발생솔칙저우 Stanford B형환자，차이균유통계학의의（균 P＜0.05）。Stanford A형환자의식장애화심포적액적발생솔명현고우Stanford B형환자（P＜0.05）。482례환자원내사망49례，병사솔위10.17％。Logistic회귀분석제시，Stanford A형（OR＝2.256，P＝0.025）화병발의식장애（OR＝4.067， P＝0.009）시주동맥협층환자사망적독립위험인소，입원서장압수평편고（OR＝0.968，P＜0.01）화수술혹개입치료（OR＝0.170，P＝0.001）시주동맥협층적보호인소。결론주동맥협층이동통위주요표현，Stanford A형、병발의식장애시도치주원사망적독립위험인소，서장압수평편고위보호인소，수술혹지가치료시강저사망솔교안전화유효적방법。
Objective To analyze the clinical characteristics of patients with aortic dissection(AD)and to investigate the factors that influence the inpatients’mortality.Methods The clinical data of 482 patients with AD were retrospectively investi‐gated ,and some relevant factors of AD were analyzed using univariate and multivariate logistic regression analyses.Results Av‐erage onset age of the patients was(54.17 ± 11.94)years old ,and the ratio of male to female was 3.63:1.00. The initial sign and symptom was pain(447 cases ,92.74% ) ,which is predominantly located in the chest and back.Incidence of chest pain was significantly higher in Stanford type A patients than in Stanford type B patients ,while incidence of abdominal pain was signifi‐cantly lower in Stanford type A patients than in Stanford type B patients(both P<0.05). The incidences of pericardial effusion and syncope were significantly higher in Stanford type A patients than in Stanford type B patients(P<0.05).Among 482 inpa‐tients ,49 patients died in hospital resulting in the mortality rate 10.17%.Logistic regression analysis illustrated that Stanford A type(OR=2.256 ,P=0.025)and complicated with unconsciousness(OR=4.067 ,P=0.009)were independent risk factors for the death of patients ,while the high diastolic blood pressure(OR=0.968 ,P<0.01)and surgical or interventional therapy(OR=0.170 ,P=0.001)were the protective factors.Conclusion Pain is the characteristic sign and symptom of AD.Stanford A type and complicated with unconsciousness are independent risk factors for hospital mortality. High diastolic blood pressure level is the protective factor and surgery or stenting therapy may be relatively safe and effective methods for AD patients.
