主动脉夹层患者住院死亡危险因素分析

目的:探讨主动脉夹层(AD)患者住院期间死亡相关危险因素。方法:回顾性分析徐州医学院附属淮安医院及东南大学附属医院2004年1月至2009年1月确诊AD120病例临床资料,按住院期间是否发生死亡进行分组,分析患者性别、体质量指数、临床症状、体征和生化指标与死亡的相关性,并用Logistic回归分析其与病死率的关系。结果:1.120例AD患者中男女性别之比为2.0:1。平均年龄(54.7±10.3)岁,急性期院内病死率17.5%;2.死亡组与存活组中:女性、舒张压、超敏C反应蛋白水平、并发意识障碍及心包填塞差异有统计学意义(P0.05);3.女性多元回归分析(OR=2.052;95%CI=1.084～4.470;P=0.010)、超敏C反应蛋白水平(OR=1.436;95%CI=1.325～1.862;P=0.008)及合并意识障碍(OR=2.370;95%CI=1.290～3.192;P=0.04)是AD死亡的独立危险因素(P0.05),舒张压水平(OR=0.532;95%CI=0.262～0.843;P=0.030)为预后保护因素。结论:AD患者中超敏C反应蛋白水平、女性、合并意识障碍,是导致急性期院内死亡的独立危险因素,舒张压水平为保护性因素。

Clinical Risk Factor and prognosis of patients with aortic dissection

Objective：To analyze the clinical risk factor and prognosis of patients with aortic dissection.Methods：Retrospective analysis of their clinical risk factors for susceptibility were conducted on clinical data of 120 patients with aortic dissection in Zhongda hospital affiliated to southeast university and huaian hosipital affiliated to Xuzhou medical college,While observing the prognosis during hospitalization and death-related risk factors.Results：Among 120 cases with AD,the male/female ratio was 2.0：1,The mean age was（54.7 ± 10.3） years old,The intrahospital mortality was 17.5% in overall patients.Their death-related factors such as female,diastolic blood pressure,high-sensitivity C-reactive protein levels,concurrent disturbance of consciousness and symptoms of pericardial tamponade were significant difference between death and survival（P 0.05）;The mortality rate was low（14% vs.75%） by surgery or stent.Logistic regression identified the following presenting variables as predictors of mortality：female（OR = 2.052;95% CI = 1.0844.470;P = 0.010）,high sensitive C-reactive protein level（OR = 1.436;95% CI = 1.325-1.862;P = 0.008）,disturbance of consciousness（OR = 2.370;95% CI = 1.290-3.192;P = 0.004）,while the diastolic blood pressure（OR = 1.563;95% CI = 1.252-2.476;P = 0.023） was protective factors.Conclusions：female,Diastolic blood pressure,high-sensitivity C-reactive protein levels,disturbance of consciousness were the independent risk factors of the mortality of AD in acute phase.