摘要
目的掌握医院收治急性主动脉夹层患者的流行病学特征, 分析A型与B型急性主动脉夹层的D-二聚体阴性率水平, 探寻与起病时间≤24 h的D-二聚体阴性表达相关的因素。方法回顾性分析了2017年9月1日至2020年8月31日在中南大学湘雅医院急诊科经CTA、MRI或B超确诊的急性主动脉夹层患者的年龄、性别、临床表现、既往病史和实验室检查数据, 排除标准包括:(1)主动脉瘤患者;(2)主动脉壁间血肿患者;(3)主动脉穿透性溃疡患者;(4)既往有主动脉夹层手术史的患者, 但此次CTA未显示新发夹层。主动脉夹层采用Stanford分型法。将患者分为起病时间≤24 h和起病时间1~14 d两组进行分析。所有统计分析均使用GraphPad Prism 9进行。对于正态分布, 采用Student’’st检验, 对于非正态分布的连续变量, 采用Mann-WhitneyU检验。组间率的比较使用χ^(2)检验或Fisher精确检验。采用二元logistic回归分析以确定与起病时间≤24 h的D-二聚体表达正常组(阴性表达)相关的影响因素。以P<0.05为差异具有统计学意义。结果本研究共纳入急性主动脉夹层患者352例, 男性患者占79.26%, 有高血压病史者占70.45%, A型与B型夹层患者比例约为2∶3。D-二聚体总体阴性率为13.64%, A型夹层的D-二聚体阴性率显著低于B型夹层的D-二聚体阴性率(7.09%vs. 18.01%, P=0.004)差异有统计学意义。共计17例患者在急诊科内死亡, 总体病死率为4.83%, A型夹层患者病死率显著高于B型夹层, P<0.05, 差异有统计学意义。共计有235例(66.76%)的急性主动脉夹层患者的起病时间≤24 h, 在≤24 h的超急性期, D-二聚体正常和升高组患者之间的性别、年龄、基础疾病、生命体征等方面的差异无统计学意义(P>0.05), 在实验室检验结果中, D-二聚体正常组患者的血小板、血尿素氮、肌酐、乳酸脱氢酶、肌红蛋白、纤维蛋白降解物、凝血酶原时间和国际标准化比�
Objective To determine the epidemiological characteristics of acute aortic dissectionand the negative rate of D-dimer of type A and B acute aortic dissection,and to explore the factors related to the negative rate of D-dimer with onset time≤24 h.Methods The stady retropectively analyzed the age,sex,clinical mafestations,medical history,and lboatory test data of patients with acute aortic isction in the Emergency Department of Xiangya Hospital of Central South University fom September 1,2017 to August 31,2020.Exclusion citeria included 1)aortic aneuysmn,2)intermunal aorti bematoma,3)penetrating aortic ulcer,and 4)patients with prior aortic dsetion,but D0 DeW hairclip was sbown om this CTA.Stanford typing was used for sortic disctio.The patients were divided into two goups for alysis:onset timne≤24 h and onset time in 1-14 days.All stistial analyses were performed using GraphPad Prism 9.Student t-test was used for nomal distribution and Mann-Whimey U test for nonmally dstibuted contimuous variables Comparisons of ratios between groups were performed using the χ^(2) test or Fisher's exact test.Bimary logitic rgressioa analysis was performed to idenify independent fuctors rehated to the negative rate of D dimer.A P<0.05 was considered siscally sigifcnt.Results A total of 352 patients with acute aortie dssctiono were included in this study.Male patients accounted for 79.26%,patents with a history of hypertension accounted for 70.45%,and the ratio of patiats with type A:B acute sortic dssctioi.was 23.The overall negtive rate of D dimer was 13.64%.The negaive rate of D-dimer of type A acute aortic dssetionio(7.09%)was sgnificantly lower than that of type B acute aotie dsetio(7.09%vs.18.01%,P=0.004).A total of 17 patients died in the emergency depurtment,with n overall mortality rate of 4.83%.The mortality rate of type A acute aotic dsstiso patietis was sgnifcanty higbher than that of type B acute soric dstio(P<0.05).A total of 235 patients(6.76%6)with acute sortie dsesctiosto had an onset time of≤24 h.In the hype
作者
张方杰
黄国庆
李湘民
Zhang Fangjie;Huang Guoqing;Li Xiangmin(Department of Emergency,Xiangya Hospital,Central South University,Changsha 410008,China;National Clinical Research Center for Geriatric Diseases(Xiangya Hospital),Changsha 410008,China)
出处
《中华急诊医学杂志》
CAS
CSCD
北大核心
2022年第7期915-921,共7页
Chinese Journal of Emergency Medicine
基金
湖南省自然科学基金面上项目(2022JJ1138)
睿E(意)急诊医学研究专项基金(R2019007)。
