摘要目的 探讨床旁超声心动图在Stanford A型主动脉夹层诊断和院内死亡风险评估中的价值.方法 回顾性分析2009年1月至2016年1月在复旦大学附属中山医院经CT血管成像确诊的229例Stanford A型主动脉夹层患者的临床资料.根据是否发生院内死亡,将患者分为存活组(191例)和死亡组(38例).分析Stanford A型主动脉夹层患者的床旁超声心动图表现,并采用多因素logistic回归分析患者发生院内死亡的影响因素.结果 (1)死亡组接受手术治疗的比率小于存活组[60.52％(23/38)比85.34％(163/191),P＜0.01];存活组与死亡组的年龄、性别、Debakey分型、合并高血压病史和马凡综合征比率差异均无统计学意义(P均＞0.05).(2)床旁超声心动图显示,死亡组主动脉瓣受累和主动脉瓣重度反流比率均高于存活组[分别为65.79％(25/38)比34.03％(65/191)和44.74％(17/38)比14.14％(27/191),P均＜0.01];死亡组的主动脉根部直径大于存活组[(55.5 ±6.4)mm比(42.3±7.8)mm,P＜0.01];心包积液、主动脉窦部扩张比率和左心室射血分数差异均无统计学意义(P均＞0.05).(3)多因素logistic回归分析显示,主动脉瓣受累(OR=3.275,95％CI 1.290 ～ 8.313,P＜0.05)、主动脉根部直径(OR=1.202,95％CI 1.134 ～1.275,P＜0.01)和接受手术(OR=0.224,95％ CI0.079 ～0.629,P＜0.01)是Stanford A型主动脉夹层患者院内死亡的独立影响因素.结论 床旁超声心动图对Stanford A型主动脉夹层有重要诊断价值;主动脉瓣受累、主动脉根部直径增大和未接受手术是Stanford A型主动脉夹层患者院内死亡的危险因素.

abstractsObjective To investigate the value of bedside echocardiography in diagnosis and risk assessment of in-hospital death of patients with Stanford type A aortic dissection.Methods The clinical data of 229 patients with Stanford type A aortic dissection diagnosed by CT angiography in Zhongshan Hospital affiliated to Fudan University between January 2009 and January 2016 were retrospectively analyzed.The patients were divided into survival group (191 cases)and non-survival group (38 cases) according to presence or absence of in-hospital death.The bedside echocardiography features were analyzed,and influence factors of in-hospital death were determined by multivariate logistic regression analysis.Results (1) Compared with the survival group,the non-survival group had lower surgery rate (60.52％ (23/38) vs.85.34％ (163/191),P ＜0.01).Age,gender and Debakey classification were similar between survival group and death group (all P ＞ 0.05).(2) The bedside echocardiography results showed that prevalence of aortic valve involvement (65.79％ (25/38) vs.34.03％ (65/191),P ＜ 0.01) and severe aortic regurgitation (44.74％ (17/38) vs.14.14％ (27/191),P ＜ 0.01) were significantly higher in non-survival group than in survival group.The non-survival group had larger aortic root diameter than the survival group ((55.5 ± 6.4)mm vs.(42.3 ± 7.8)mm,P ＜ 0.01).There were no significant differences in pericardial effusion,expansion of aortic sinus,and left ventricular ejection fraction between survival group and non-survival group (all P ＞ 0.05).(3) The multivariate logistic regression analysis showed that aortic valve involvement(OR =3.275,95％ CI 1.290-8.313,P ＜ 0.05),aortic root diameter (OR =1.202,95％ CI 1.134-1.275,P ＜ 0.01),and surgery (OR =0.224,95％ CI 0.079-0.629,P ＜ 0.01) were independent risk factors for in-hospital death in patients with Stanford type A aortic dissection.Conclusions Bedside echocardiography has significant diagnostic value for Stanford type A aortic dissection.Aortic valve involvement,enlargement of aortic root diameter and without surgery are independent risk factors for patients with Stanford type A aortic dissection.