急性Stanford B型主动脉夹层并发症及其与预后的关系

目的 研究急性Stanford B型主动脉夹层并发症及其与预后的关系,寻找影响预后的因素.方法 回顾性分析84例急性Stanford B型主动脉夹层患者的临床资料,统计是否并发心包积液、胸腔积液、意识障碍、少尿、消化道出血等并发症以及肌酸激酶水平,分析其与预后的关系.84例患者中,男73例,女11例;年龄30～81(52.0±12.7)岁.结果 总体病死率为9.5%(8/84).并发心包积液患者病死率为33.3%(1/3),胸腔积液患者病死率为35.7%(5/14),消化道出血患者病死率为50.0%(2/4),少尿患者病死率为100.0%(2/2),意识障碍患者病死率为100.0%(1/1),肌酸激酶升高者病死率为36.4%(4/11).出现并发症的病例,病死率均较总体高,出现胸腔积液、消化道出血、少尿、意识障碍和肌酸激酶升高的患者与无相应并发症的患者相比病死率升高,差异有统计学意义(P＜0.05).Logistic回归分析表明,胸腔积液是独立预测死亡的指标.结论 急性Stanford B型主动脉夹层患者出现胸腔积液、消化道出血、少尿、意识障碍或肌酸激酶升高时病死率增加,胸腔积液是独立的预测死亡的指标.

Complications of acute Stanford type B aortic dissection and prognosis

Objective To find the death predictors of acute Stanford type B aortic dissection patients by studying relationships between complications and prognosis. Methods Eighty-four patients with acute Stanford type B aortic dissection were included, the complications of pericardial fluid, pleural effussion,conscious disturbance ,oliguria, gastrointestinal tract bleeding and the level of creatine kinase were analyzed.There were 73 men and 11 women with age 30 - 81 (52.0±12.7) years old. Results The overall mortality was 9.5％(8/84). There were 33.3％ (1/3) died with pericardial fluid, 35.7％ (5/14) died with pleural effussion, 50.0％ (2/4) died with gastrointestinal tract bleeding, all patients died with oliguria and conscious disturbance, 36.4％(4/11 ) patients died with elevated creatine kinase. The patients suffered from any of the complications had higher mortality than those free from complications. There was significant difference between patients suffering from pleural effussion, gastrointestinal tract bleeding, oliguria,conscious disturbance and high level of creatine kinase and who not suffering from the complications respectively in statistically (P ＜ 0.05 ). Logistic regression showed that pleural effussion was independent death predictor.Conclusions The mortality increases when acute Stanford type B aortic dissection patients combined with pleural effussion, gastrointestinal tract bleeding,oliguria, cons cious disturbance or high level of creatine kinase. Pleural effussion is independent death predictor.