Division of Cardiology, Department of Medicine, University of Hong Kong, Queen Mary Hospital, Hong Kong, China.
Clin Cardiol. 2011 Mar;34(3):E1-5. doi: 10.1002/clc.20481.
The purpose of this study was to describe the clinical characteristics and clinical outcomes for Chinese patients with type A intramural hematoma (IMH).
We studied 90 patients with Stanford type A acute aortic syndrome who presented to our institution from 1998 to 2005 and evaluated the presentation, management, and clinical outcomes of acute IMH by comparing these patients with those diagnosed with classical aortic dissection (AD). A total of 34 patients had IMH and they tended to be older (69.7 ± 12.4 versus 60.5 ± 16.2 years; p=0.006). The development of pericardial effusion was more frequent in patients with IMH than in patients with AD. They were also less likely to receive surgery as compared to AD patients (26.5% versus 73.2%; p<0.0001). Overall mortality of IMH was not significantly higher than that of classic AD (29.4% versus 21.4%; p=0.45). For IMH patients, the mortality rate with medical treatment was 32%. Ten (40%) of the 25 medically treated patients developed adverse outcomes. However, no independent predictors of adverse outcomes were identified in the study. In follow-up imaging studies of 15 patients who survived IMH without surgical repair, 14 patients showed complete resolution of IMH and 1 progressed into classical AD.
Acute type A IMH in Chinese patients showed a high mortality rate with medical treatment. It has a highly unpredictable course with no reliable clinical and anatomical predictors. Surgical therapy should be the treatment of choice for Chinese patients with acute IMH, especially those who are younger and have less comorbidities.
本研究旨在描述中国人群 Stanford A 型主动脉壁内血肿（IMH）患者的临床特征和临床结局。
我们研究了 1998 年至 2005 年期间我院收治的 90 例 Stanford A 型急性主动脉综合征患者，通过比较这些患者与经典主动脉夹层（AD）患者，评估急性 IMH 的表现、处理和临床结局。共有 34 例患者为 IMH，且这些患者年龄较大（69.7±12.4 岁比 60.5±16.2 岁；p=0.006）。IMH 患者心包积血的发生率高于 AD 患者。与 AD 患者相比，他们接受手术治疗的可能性也较低（26.5%比 73.2%；p<0.0001）。IMH 的总体死亡率与经典 AD 无显著差异（29.4%比 21.4%；p=0.45）。对于 IMH 患者，药物治疗的死亡率为 32%。25 例接受药物治疗的患者中，有 10 例（40%）出现不良结局。然而，本研究未发现不良结局的独立预测因素。在 15 例未接受手术治疗的 IMH 存活患者的随访影像学研究中，14 例患者的 IMH 完全消退，1 例进展为经典 AD。
中国人群急性 A 型 IMH 患者药物治疗死亡率较高。其病程具有高度不可预测性，目前尚无可靠的临床和解剖学预测指标。对于急性 IMH 患者，尤其是年龄较小且合并症较少的患者，手术治疗应作为首选治疗方法。
