Stanford A型主动脉夹层年轻患者的临床特点

目的分析Stanford A型主动脉夹层年轻患者的临床特点。方法回顾性分析2004年3月至2011年6月解放军总医院行外科手术治疗的Stanford A型主动脉夹层患者54例的临床资料,以40岁为界将患者分为两组:年轻患者组23例,男17例,女6例;年龄(34.2±6.3)岁;对照组31例,男27例,女4例;年龄(51.5±6.8)岁。分析两组患者临床和手术治疗特点。结果两组患者术中体外循环时间[(224.4±83.1)min vs.(215.0±88.0)min,t=0.39,P=0.69]和主动脉阻断时间[(152.3±60.8)min vs.(130.9±51.2)min,t=1.34,P=0.18]差异无统计学意义。与对照组相比,年轻患者组中先天畸形(包括马方综合征及主动脉瓣二叶畸形)的发生率较高[34.7%(8/23)vs.6.4%(2/31),χ2=5.27,P=0.02],年轻患者术后精神及神经系统并发症明显较低[4.3%(1/23)vs.32.2%(10/31),χ2=5.32,P=0.02],而两组院内死亡率差异无统计学意义[13.0%(3/23)vs.12.9%(4/31),χ2=0.15,P=0.69]。结论年轻Stanford A型主动脉夹层患者中,心血管危险因素较少,而主要为先天性疾病,手术方式更积极,术后精神及神经系统并发症发生率较低。

Clinical Characteristics of Young Patients with Stanford Type A Aortic Dissection

Objective To summarize the clinical characteristics of young patients with Stanford type A aortic dissection.Methods We retrospectively analyzed 54 patients with Stanford type A aortic dissection who received surgical treatment in General Hospital of PLA between March 2004 and June 2011.All the patients were divided into two groups: a young patient group with patients’ age less than 40 years and a control group with patients’ age more than or equal to 40 years.There were 23 patients including 17 males and 6 females with an average age of 34.2±6.3 years in the young patient group and 31 patients including 27 males and 4 females with an average age of 51.5±6.8 years in the control group.The clinical characteristics and surgical treatment outcomes of the two groups were compared.Results There was no statistical difference in cardiopulmonary bypass(CBP) time(224.4±83.1 min vs.215.0±88.0 min,t=0.39,P=0.69) and aortic cross-clamping time(152.3±60.8 min vs.130.9±51.2 min,t=1.34,P=0.18) between the two groups.Compared with the patients in the control group,young patients were more likely to have congenital malformations with rate at 34.7%(8/23) vs.6.4%(2/31) with χ2=5.27,P=0.02,such as Marfan syndrome and bicuspid aortic valve.The mortality of the young patients was similar to patients in the control group at rate of 13.0%(3/23) vs.12.9%(4/31) with χ2=0.15 and P=0.69,but postoperative mental and neurological complications rate in the young patient group were less frequent than those in the control group at 4.3%(1/23) vs.32.2%(10/31) with χ2=5.32 and P=0.02.Conclusion Young patients with Stanford type A aortic dissection have fewer cardiovascular risk factors for aortic dissection but are more likely to have congenital malformations.The surgical methods are more active for young patients with less frequency of postoperative mental and neurological complications.