摘要
目的比较单纯局限的升主动脉夹层患者与单纯升主动脉扩张患者的升主动脉内径及术后结局,探讨现有指南指导国人升主动脉扩张患者手术时机选择的可靠性。方法回顾性分析2010~2017年139例在首都医科大学附属北京安贞医院接受手术治疗的主动脉扩张及主动脉夹层住院患者的临床资料。排除合并马方综合征、心脏瓣膜等病变的患者后,分为单纯局限的升主动脉夹层组(83例)及单纯升主动脉扩张组(56例)。比较两组患者的升主动脉内径及术后结局。结果在主动脉内径方面,单纯升主动脉扩张组的升主动脉内径[(57.30±9.41)mm vs.(50.72±9.53)mm,P<0.001]及升主动脉内径指数(31.12±5.38 vs.27.22±6.40,P<0.001)均大于单纯局限的升主动脉夹层组。对于男性患者,结果也是相似的[(60.28±10.80)mm vs.(47.40±6.53)mm;30.00±6.33 vs.23.60±3.72,P<0.001]。但女性患者中两组间差异无统计学意义[(54.90±7.47)mm vs.(53.81±10.84)mm;32.03±4.37 vs.30.58±6.56,P均>0.05]。对于术后结局而言,单纯局限的升主动脉夹层组死亡率较高,气管切开术发生率较高,术后出血再探查率较高。结论本研究中升主动脉发生夹层时患者的升主动脉内径多数<5.5 cm,因此仅凭现有指南指导国人升主动脉扩张患者手术时机选择是不够的,在未来的临床研究中,我们还需要明确更加合理的指标。
Objective To compare the ascending aortic diameter and postoperative outcomes of patients with simple ascending aortic dissection or simple ascending aortic dilatation and to study the reliability of the surgical indication in present guideline for Chinese patients with ascending aortic dilatation.M ethods The clinical data of patients with aortic aneurysm and aortic dissection who underwent surgery at Beijing Anzhen Hospital,Capital Medical University from 2010 to 2017 were retrospectively reviewed.After exclusion of patients with Marfan syndrome,heart valve and other diseases,139 patients were divided into two groups:a simple ascending aorta dilatation group(56 patients)and a simple ascending aortic dissection group(83 patients).The ascending aortic diameter and postoperative outcomes of two groups were compared.Results The inner ascending aortic diameter(57.30±9.41 mm vs.50.72±9.53 mm,P<0.001)and the inner ascending aortic diam eter index(31.12±5.38 vs.27.22±6.40,jP<0.001)in the simple ascending aorta dilatation group were significantly greater than those in the simple ascending aortic dissection group.For male patients,the results were similar(60.28±10.80 mm vs.47.40±6.53 mm;30.00±6.33 vs.23.60±3.72,both P<0.001).But for the female patients,there was no significant difference between the two groups(54.90±7.47 mm vs.53.81±10.84 mm;32.03±4.37 vs.30.58±6.56,both P>0.05).The mortality,the incidence of tracheotom y and postoperative reopen rate in the simple ascending aortic dissection group were higher.Conclusion In this study,the inner diameter of the ascending aorta in the group of ascending aorta is mostly<5.5 cm.In our opinion,the present surgical indication for Chinese patients with ascending aortic dilatation is not enough.In the future clinical studies,we also need to find more reasonable surgical indications.
作者
姜文剑
刘扬
余长遥
张宏家
JIANG Wenjian;LIU Yang;YU Changyao;ZHANG Hongjia(Department of Cardiac Surgery,Beijing Institute of Heart Lung and Blood Vessel Diseases,Beijing Anzhen Hospital,Capital Medical University,Beijing,100029,P.R.China)
出处
《中国胸心血管外科临床杂志》
CAS
CSCD
2019年第11期1113-1118,共6页
Chinese Journal of Clinical Thoracic and Cardiovascular Surgery
基金
科技部国家重点研发计划项目（2017YFC1308000）
国家自然科学基金（81800404
81470580）
心血管疾病精准医学北京实验室（PXM2017_014226_000037）
北京市优秀人才培养资助青年骨干个人项目（2017000021469G254）
首都卫生发展科研专项项目—青年优才（2018-4-2068）
北京市医院管理局青年人才培养“青苗”计划（QML20180601）
关键词
单纯升主动脉扩张
单纯局限的升主动脉夹层
升主动脉内径
外科手术指征
Simple ascending aortic dilation
simple ascending aortic dissection
inner diameter of ascending aorta
surgical indication
