CAJ | 학술논문

目的：分析主动脉夹层（AD）患者院内死亡的相关危险因素。方法回顾性分析厦门市心脏中心2002年1月至2011年10月确诊急性AD患者175例的临床资料，其中男性129例，女性46例，平均年龄（56.8±12.1）岁。按住院期间是否死亡进行分组，分为存活组（n=141）及死亡组（n=34），分析年龄、性别、既往病史、血压水平、症状、并发症及实验室指标与死亡的相关性，并用Logistic回归分析危险因素与病死率的关系。结果与存活组比较，死亡组D-二聚体水平升高，意识障碍和心包填塞比例增加，手术或支架治疗比例减少，差异有统计学意义（P均＜0.05）。Logistic回归分析结果表明， D-二聚体水平升高（OR=1.325，95%CI：1.436~1.973，P=0.004）、伴意识障碍（OR=2.481，95%CI：1.302~3.203，P=0.003）、心包填塞（OR=7.726，95%CI：1.762~34.003，P=0.008）为AD患者住院死亡的独立危险因素，手术或介入治疗（OR=0.101，95%CI：1.762~34.003，P=0.044）为保护因素。结论AD患者中D-二聚体明显升高，并发意识障碍、心包填塞者病死率高，临床上应予高度重视，依据病情采取手术或介入治疗有利于降低AD患者的病死率。
목적：분석주동맥협층（AD）환자원내사망적상관위험인소。방법회고성분석하문시심장중심2002년1월지2011년10월학진급성AD환자175례적림상자료，기중남성129례，녀성46례，평균년령（56.8±12.1）세。안주원기간시부사망진행분조，분위존활조（n=141）급사망조（n=34），분석년령、성별、기왕병사、혈압수평、증상、병발증급실험실지표여사망적상관성，병용Logistic회귀분석위험인소여병사솔적관계。결과여존활조비교，사망조D-이취체수평승고，의식장애화심포전새비례증가，수술혹지가치료비례감소，차이유통계학의의（P균＜0.05）。Logistic회귀분석결과표명， D-이취체수평승고（OR=1.325，95%CI：1.436~1.973，P=0.004）、반의식장애（OR=2.481，95%CI：1.302~3.203，P=0.003）、심포전새（OR=7.726，95%CI：1.762~34.003，P=0.008）위AD환자주원사망적독립위험인소，수술혹개입치료（OR=0.101，95%CI：1.762~34.003，P=0.044）위보호인소。결론AD환자중D-이취체명현승고，병발의식장애、심포전새자병사솔고，림상상응여고도중시，의거병정채취수술혹개입치료유리우강저AD환자적병사솔。
Objective To analyze the relative risk factors of in-hospital death in patients with aortic dissection (AD).Methods The clinical materials of patients with acute AD [n=175, male 129, female 46 and average age was (56.8±12.1)] were analyzed retrospectively from Jan. 2002 to Oct. 2011, and all patients were divided into survival group (n=141) and death group (n=34). The correlation between age, sex, medical history, blood pressure level, symptoms, complications or laboratory indexes and death was analyzed, and the relatio level increased, and the percentage of patients with consciousness disorder and cardiac tamponade increased and percentage of patients with surgery or stenting decreased (allP<0.05). The results of Logistic regression analysis showed that increased D-dinship between risk factors and mortality was analyzed by using Logistic regression analysis.Results Compared with survival group, in death group D-dimermer level (OR=1.325, 95%CI: 1.436~1.973,P=0.004), consciousness disorder (OR=2.481, 95%CI: 1.302~3.203,P=0.003) and cardiac tamponade (OR=7.726, 95%CI:1.762~34.003,P=0.008) were independent risk factors of in-hospital death, and surgery or interventional treatment (OR=0.101, 95%CI: 1.762~34.003,P=0.044) were protective factors in AD patients.Conclusion Mortality is higher in patients with increased D-dimer level or complicating consciousness disorder and cardiac tamponade. Surgery and interventional treatment can reduce the mortality.