發(fā)布時(shí)間：2018-04-23 00:33

  本文選題：急性主動(dòng)脈夾層 + 臨床特點(diǎn)　； 參考：《安徽醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的研究分析急性主動(dòng)脈夾層患者的臨床特點(diǎn)和院內(nèi)死亡的危險(xiǎn)因素。方法回顧性分析2013年1月至2015年12月住院的270例急性主動(dòng)脈夾層患者的總體臨床資料,包括發(fā)病時(shí)間、發(fā)病年齡、性別、既往史、主訴、生命體征、實(shí)驗(yàn)室檢查、住院期間并發(fā)癥、院內(nèi)死亡率;比較Stanford A型和Stanford B型急性主動(dòng)脈夾層患者臨床資料;根據(jù)患者出院情況分為死亡組和存活組,分析急性主動(dòng)脈夾層患者院內(nèi)死亡危險(xiǎn)因素,并進(jìn)一步分析其院內(nèi)死亡的獨(dú)立危險(xiǎn)因素。結(jié)果1.急性主動(dòng)脈夾層患者平均發(fā)病年齡55.7±12.7歲,男女比例3.03:1,合并高血壓病201例(74.4%),馬凡綜合征5例(1.9%),吸煙史77例(28.5%),有疼痛表現(xiàn)235例(87.0%),入院時(shí)收縮壓、白細(xì)胞計(jì)數(shù)、D-二聚體水平高于正常,并發(fā)腎功能不全45例(16.7%),心包積液48例(17.8%),主動(dòng)脈瓣關(guān)閉不全49例(18.1%),院內(nèi)死亡44例(16.3%)。2.急性主動(dòng)脈夾層好發(fā)于冬春季節(jié),兩型急性主動(dòng)脈夾層均高發(fā)于1月、11月、12月。Stanford A型和Stanford B型急性主動(dòng)脈夾層好發(fā)年齡均在40-69歲,Stanford B型急性主動(dòng)脈夾層在高齡(年齡70歲)患者中仍占有較大比例。3.Stanford A型較Stanford B型急性主動(dòng)脈夾層患者平均發(fā)病年齡小,入院時(shí)收縮壓、舒張壓水平較低,D-二聚體水平較高,并發(fā)腎功能不全、心包積液、主動(dòng)脈瓣關(guān)閉不全比例高,院內(nèi)死亡比例較高,差異均有統(tǒng)計(jì)學(xué)意義(P0.05)。4.與存活組比較,死亡組患者入院時(shí)收縮壓、舒張壓水平較低,D-二聚體水平較高,Stanford A型比例較高,并發(fā)腎功能不全、心包積液比例較高,差異均有統(tǒng)計(jì)學(xué)意義(P0.05)。進(jìn)一步多因素Logistic回歸分析,結(jié)果示入院時(shí)收縮壓水平偏低,D-二聚體水平偏高,Stanford A型,并發(fā)腎功能不全、心包積液是急性主動(dòng)脈夾層患者院內(nèi)死亡的獨(dú)立危險(xiǎn)因素。結(jié)論1.急性主動(dòng)脈夾層好發(fā)于冬春季節(jié),常見于中老年男性。急性主動(dòng)脈夾層患者常合并高血壓、吸煙史,臨床多表現(xiàn)為疼痛,入院時(shí)收縮壓水平、白細(xì)胞計(jì)數(shù)、D-二聚體水平較高,并發(fā)癥比例較高,院內(nèi)死亡率較高。2.Stanford A型急性主動(dòng)脈夾層患者較Stanford B型平均發(fā)病年齡小,入院時(shí)血壓水平低,D-二聚體水平高,易合并并發(fā)癥及出現(xiàn)院內(nèi)死亡。3.入院時(shí)收縮壓水平偏低、D-二聚體水平偏高、Stanford A型、并發(fā)腎功能不全、心包積液是急性主動(dòng)脈夾層患者院內(nèi)死亡的獨(dú)立危險(xiǎn)因素,臨床應(yīng)予以重視。
[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 鹵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.
【學(xué)位授予單位】：安徽醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R543.1

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