摘要
目的探讨急性主动脉综合征（acute aortic syndrome，AAS）患者的临床特征及预后相关因素。方法收集北京大学人民医院2000年1月至2015年12月急诊及住院的AAS患者的临床资料，分析其临床特征、辅助检查及预后相关因素。结果391例AAS患者的年龄为（52．7±13．3）岁，男女比例4．3：1。其中73．4％的AAS患者存在高血压，约半数未规律口服降压药物或者血压控制不佳；疼痛为AAS患者最常见临床表现，占90．0％以上，疼痛性质以转移性或扩展性疼痛多见，疼痛范围扩大提示夹层进展。91．1％的AAS患者D-二聚体水平升高，且A型AAS患者显著高于B型。超声／超声心动检查诊断AAS的敏感度为88．4％，在A型AAS患者中的敏感度可达99．1％；A型AAS患者的病死率显著高于B型患者（34.3％vs．0．9％，P〈0．01），经手术／支架治疗的AAS患者住院期间的病死率明显下降（11．7％vs．28．0％，P〈0．01）。AAS患者死亡组较存活组白细胞计数、中性粒细胞／淋巴细胞（neutrophil to lymphocyte ratio，NLR）、纤维蛋白原降解产物（fibrinogen degradation product，FDP）及D．二聚体均升高（P均〈0．01），血小板计数（P〈0．05）及纤维蛋白原（fibrinogen，FIB）均降低（P〈0．01）。结论疼痛是AAS的特征性临床表现，多为突发，剧烈或撕裂样，呈转移性或扩展性；D-二聚体及超声检查方便宜行，对AAS诊断价值高；AAS死亡组患者较存活者白细胞计数、NLR、FDP及D-二聚体升高，血小板计数及FIB降低。A型AAS患者病死率显著高于B型，手术、支架治疗可显著降低AAS患者住院期间病死率。
Objective To investigate the clinical characteristics and associated prognostic factors of the acute aortic syndrome. Methods The clinical data of 391 patients with acute aortic syndrome （AAS） admitted to Beijing University People＇s Hospital from January 2000 to December 2015 were analyzed. Results In 391 patients with AAS, the average age was （52.7±13.3） with a male/female ratio of 4.3：1, and 73.4% patients had hypertension. The most common clinical manifestation of patients with AAS was pain accounting for more than 90.0%, and the nature of pain was expansible and/or transitive pain. The level of D-dimer was elevated in 91.1% of patients with AAS （ELISA）, and significantly higher in type A patients than type B patients. Ultrasound/echocardiography was used to diagnose AAS with a sensitivity of 88.4%, of which the sensitivity of type A patients was 99.1%; the mortality of type A patients was significantly higher than type B patients （34.3% vs. 0.9%, P 〈0.01）. The mortality was declined obviously （11.7% vs. 28.0%, P 〈0.01） when patients were treated with stent. Compared with the in-hospital surviving group, the in-hospital mortality group had decreased platelet counts and FIB, higher level of D-dimer, FDP and NLR （neutrophil to lymphocyte ratio）. Conclusions Transitive and（or） expansible pains were the characteristic clinical manifestations of acute aortic syndrome,which usually happened suddenly or tearing; D - dimer and ultrasound were valueble and simple methods in AAS patients; Compared with In-hospital surviving group,the In-hospital mortality group had decreased platelet counts and FIB,higher level of D-dimer, FDP and NLR.The mortality of type A was significantly higher than type B,operation can lower the mortality of AAS patients obviously.
作者
窦丽稳
高伟波
吴春波
曹宝平
朱继红
Dou Liwen;Gao Weibo;Wu Chunbo;Cao Baoping;Zhu Jihong(Emergency Department,Peking University People＇s Hospital Beijing,100044,China)
出处
《中华急诊医学杂志》
CAS
CSCD
北大核心
2018年第10期1101-1106,共6页
Chinese Journal of Emergency Medicine
