摘要目的 分析保守治疗的急性Stanford B型主动脉夹层患者急性期(发病14 d内)的死亡相关因素,指导急诊手术病例的选择.方法 回顾分析2007年1月至2009年5月进行保守治疗的42例急性Stanford B型主动脉夹层患者,其中男性33例,女性9例,平均年龄(50±12)岁.治疗方法包括止痛、控制性降压及抑制心肌收缩等对症治疗.其中急性期存活28例,死亡14例,分别应用单因素和多因素Logistic回归分析寻找其急性期死亡的相关因素.结果 在单因素Logistic回归分析中,分支血管缺血(P=0.018)和主动脉最大径(P=0.002)是急性期B型夹层的死亡相关因素;多因素Logistic回归分析亦证实分支血管缺血(P=0.041)和主动脉最大径(P=0.005)为死亡的相关因素.当主动脉最大径超过40 mm时死亡风险明显增高(P=0.000).结论 存在主动脉分支血管缺血或主动脉最大径>40 mm的急性Stanford B型主动脉夹层患者应考虑急诊手术或腔内治疗.

abstractsObjective To analyze the death-related risk factors of type B aortic dissection treated medically during the acute phase (symptoms presenting within 14 d), and to determine the predictors of surgical indications for acute type B aortic dissection. Methods Clinical data of 42 patients with acute type B aortic dissection admitted from January 2007 to May 2009 was retrospectively reviewed. There were 33 male and 9 female with a mean age of (50 ± 12 ) years old. Therapy included analgesia, controlled hypotension and β-receptor blocker, the mortality in acute phase was 33.3% ( 14/42 ). Univariate and multivariate logistic regression analyses were performed to identify the predictors of the death in acute phase. Results In univariate logistic regression analysis, the malperfusion of aortic branches (P= 0. 018 ) and maximum aortic diameter (P = 0. 002) were significant predictors of death. In the multivariate logistic regression model, the malperfusion of aortic branches ( P = 0. 041 ) and maximum aortic diameter ( P= 0. 005 ) were also considered as the significant death-related factors. Risk of death augmented significantly ( P= 0. 000) when the maximum aortic diameter over 40 mm. Conclusion Malperfusion of aortic branches and the large maximum aortic diameter ( >40 mm) are the indications of surgery or endovascular therapy for acute type B aortic dissection.