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目的回顾性分析总结主动脉夹层住院患者的流行病学特征和临床特征。方法对2003—2013年符合主动脉夹层诊断的232例患者的一般情况、发病时间、临床症状与体征、诊断与延误诊断及治疗情况进行回顾性分析。计数资料比较采用χ2检验,P<0.05为差异有统计学意义。结果 232例患者中,男171例,女61例,年龄(58.21±12.24)岁,分为A型91例,B型141例。以1、2、11、12月发病率最高,4个月中A型发病例数占总例数的51.65%,B型发病例数占总例数的53.90%。A型患者胸痛、胸闷心悸、晕厥及神志模糊等症状发生率(74.73%、23.08%、12.09%)明显高于B型(18.44%、9.93%、3.55%,均P<0.05),B型患者主要表现为肩背部疼痛(42.55%),与A型(21.98%)相比差异有统计学意义(P<0.05)。A型患者的低血压或休克、双侧肢体血压不对称、主动脉瓣区舒张期杂音、心包积液、心包填塞、急性心肌梗死、心电图改变(13.19%、39.56%、24.18%、23.08%、4.40%、6.59%、64.84%)的发生率高于B型患者(4.26%、17.02%、6.38%、4.96%、0、0、43.26%),两组比较差异均有统计学意义(均P<0.05)。经内科治疗后,好转率78.02%,病死率16.38%,未愈、放弃占5.60%,转心外科行带膜支架治疗占11.21%,行外科手术治疗占5.60%。结论主动脉夹层患者发病年龄多在50~70岁;男性多于女性;冬春季为高发季节;疼痛是主要的首发症状,可伴有心包积液、四肢血压异常、晕厥及意识障碍等症状和体征;及时结合CT、MRI、UCG等影像学检查,可大大提高诊断率,正确诊断和积极的内科治疗以及根据临床分型和病情采取外科手术、介入治疗可减少病死率和改善患者的预后。
Objective To retrospectively analyze the epidemiological characteristics and clinical features of inpatients with aortic dissection. Methods The general situation, the onset time, the clinical symptoms and signs, the diagnosis and the delay diagnosis and the treatment of 232 cases meeting the diagnosis of aortic dissection in 2003-2013 were analyzed retrospectively. Counting data using χ2 test, P <0.05 for the difference was statistically significant. Results Among the 232 patients, 171 were male and 61 were female, with a mean age of (58.21 ± 12.24) years. There were 91 A patients and 141 B patients. The incidence was the highest in January, February, November and December. The incidence of type A cases in 4 months accounted for 51.65% of the total cases, and the incidence of type B cases accounted for 53.90% of the total cases. The incidence of symptoms of chest pain, chest tightness, heart palpitations, syncope and delirium in type A patients was significantly higher than that in type B patients (74.4%, 23.8%, 12.09%, 18.44%, 9.93%, 3.55%, P < Mainly shoulder pain (42.55%), compared with type A (21.98%), the difference was statistically significant (P <0.05). A type of patients with hypotension or shock, bilateral limb blood pressure asymmetry, aortic valve area diastolic murmur, pericardial effusion, cardiac tamponade, acute myocardial infarction, ECG changes (13.19%, 39.56%, 24.18%, 23.08% 4.40%, 6.59% and 64.84% respectively) were higher than those in type B patients (4.26%, 17.02%, 6.38%, 4.96%, 0,0,43.26%), with significant difference between the two groups <0.05). After medical treatment, the rate of improvement was 78.02% and the case fatality rate was 16.38%. After healed, 56.5% of them were given up, and there were 11.21% of patients treated with stents with revascularization. Surgical treatment accounted for 5.60%. Conclusion The age of onset of aortic dissection is mostly in the range of 50-70 years; more men than women; winter is the high season; pain is the main first symptom, which may be associated with pericardial effusion, abnormal blood pressure in limbs, syncope and disturbance of consciousness Signs, and timely combined with CT, MRI, UCG and other imaging studies can greatly improve the diagnostic rate, correct diagnosis and positive medical treatment and surgical treatment based on clinical classification and condition, intervention can reduce mortality and improve patient prognosis.