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Stanford B型主动脉夹层急性期腔内修复时机选择及预后

Relations between timing of treatment in stanford B acute aortic dissection vascular repair and prognosis

摘要:

目的:探讨急性Stanford B型主动脉夹层腔内修复的临床治疗时机与预后的相关性。方法回顾性分析腔内修复治疗110例急性Stanford B型主动脉夹层患者的临床资料。依据发病到治疗时间分为三组,即A组(发病到治疗时间7 d内),B组(发病到治疗时间7~14 d内),C组(发病到治疗时间14 d以上),观察三组术后主动脉修复状况和预后的相关指标。结果 A组术后最大真腔直径与最大假腔直径比值(1.8±0.5),明显的高于B组、C组的(1.3±0.3)、(1.3±0.2),差异有统计学意义(F=7.352,P<0.05)。术前最小真腔直径与最大假腔直径比值、术后最大真腔直径与最大假腔直径比值均与发病到腔内修复术治疗时间呈现负相关性(r=-0.452、-0.281,均P<0.05)。术后并发症发生率A组12.8%,B组29.5%,C组33.3%, A组明显低于B组和C组,差异有统计学意义(χ2=4.024、4.721,均P<0.05)。A组死亡3例,B组死亡1例,C组无死亡。A组住院时间与住院费用明显的低于B组和C组,差异有统计学意义(F=4.125、7.375,均P<0.05)。结论急性Stanford B型主动脉夹层早期实施主动脉腔内修复术,能促进主动脉的重塑与修复,减少并发症,降低手术风险,改善预后,提高手术安全性。同时可缩短住院时间与治疗的费用。

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Objective To investigate clinical relevance of the acute Stanford B aortic dissection vascular repair time for treatment and prognosis.Methods A retrospective clinical data of our hospital treated 1 10 cases of vascular repair of acute aortic dissection type Stanford B were analyzed according to the onset to treatment time.They were divided into three groups:group A (onset to treatment time of 7 days),group B (onset to treatment time 14) and group C (onset to treatment time than 14 days);the three groups were observed after aortic repair status and prognosis related indicators.Results The true lumen false lumen diameter and maximum diameter ratio in group A was the largest (1.8 ±0.5),which was significantly higher than that of group B and group C (1.3 ±0.3)and (1.3 ± 0.2),the difference was statistically significant (F=7.352,P<0.05).Ratio of preoperative minimum true lumen diameter and the maximum diameter of the false lumen,ratio of postoperative maximum true lumen diameter and the maximum diameter of the false lumen were associated with the onset of the endovascular repair time,showed a negative correlation (r=-0.452,-0.281,all P<0.05).postoperative complication rate of group A was 12.8%,complica-tion rate of group B was 29.5%,complication rate of group C was 33.3%,data of group A was significantly lower than those of group B and group C,the difference were statistically significant (χ2 =4.024,4.721,all P<0.05).group A died three cases,group B had 1 patient died and in group C there was no deaths.Hospital stay and hospital costs of group A were significantly lower than those of group B and group C,the difference werestatistically significant (F=4.125,7.375,all P<0.05).Conclusion As soon as possible to implement acute aortic dissection stanford B aortic vascular repair could better improve outcomes,and reduce the cost of hospitalization and treatment.At the same time, it can reduce the incidence of complications and improve clinical safety.

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