238例主动脉夹层患者临床特征及预后分析

目的探讨238例主动脉夹层患者的临床特征、治疗及预后。方法回顾性分析新疆医科大学第一附属医院2000年1月～2009年12月10年连续收治并经影像学检查确诊为主动脉夹层238例患者，对每年患者的总数、年龄、性别、夹层类型、血压水平、治疗方法和疾病预后进行统计和比较分析。结果高血压患者主动脉夹层的发生率（73．5％）明显高于非高血压患者（26．5％），血压改变以收缩压和平均压的增高明显（P〈0．05）。有高血压的主动脉夹层患者住院期间病死率（25．1％）高于非高血压的主动脉夹层患者（9．5％）（P〈0．05）。药物治疗组的有效率为74．6％，手术治疗组有效率70．0％，血管内支架治疗的治愈率91．4％，介入治疗组其有效率高于保守治疗及手术治疗组（P〈0．05）。A型主动脉夹层较B型主动脉夹层发病平均年龄低。急性A型主动脉夹层住院病死率（36．2％）高于急性B型主动脉夹层住院病死率（9．6％）（P〈0．05）。结论主动脉夹层的住院患者在迅速增多，平均发病年龄明显低于国外报道。主动脉夹层发生的危险性与收缩压的关系比较密切，有高血压的主动脉夹层患者早期死亡率较高。主动脉夹层的预防与治疗方面亟待更多的关注与探索。

Clinical characteristics, therapy and prognosis of 238 cases with aortic dissection

Objective To discuss the clinical features, therapy and prognosis of aortic dissection （AD）. Methods Retrospective analysis of consecutive 238 patients with AD over 10 years in The First Affiliated Hospital of Xinjiang Medical University. Hospital records and prognosis were compared. Results Hypertension was present in 73.5% of all patients. The mortality in patients treated by medical therapy was 74.6%, by surgical treatment 70.0%, and by intravascular stent 91. 4%. Type A dissection were identified 102 cases of all the cases, type B was 136 cases. In -hospital mortality of acute type A dissection was 36.2%, acute type B dissection 9.6%. Conclusion The number of hospitalized patients with AD is increasing dramatically. The mean age of the first - attack is much younger than that reported by other regional researchers. SBP and mean BP are the main risk factors related to the occurrence of AD. AD patients with hypertension often died at the earlier stage. These data support the urgent need for further improvement in prevention and treatment of AD.