Li Zhuo-Dong, Liu Yang, Zhu Jiang, Wang Jun, Lu Fang-Lin, Han Lin, Xu Zhi-Yun
Department of Cardiothoracic Surgery, Changhai Hospital, Second Military Medical University, Shanghai 200433, China.
J Thorac Dis. 2017 Dec;9(12):4979-4987. doi: 10.21037/jtd.2017.11.59.
Aortic rupture is one of the main causes of early death in acute and subacute Stanford type A aortic dissection (ATAAD) patients. This study aimed to analyze potential risk factors for pre-operational aortic rupture in ATAAD patients.
We retrospectively reviewed aortic dissection cases treated between May 2013 and May 2016 in Changhai Hospital, Shanghai. A total of 329 patients with ATAAD were included in the final analysis, and 31 patients died of aortic rupture before surgery. Clinical data on basic characteristics, clinical presentation, and biochemical measurements for all 329 patients were analyzed.
The in-hospital aortic rupture rate was 9.4% (31/329), and the rupture accounted for 47% (31/66) of all in-hospital deaths of ATAAD patients. Patients who experienced rupture were significantly older (P<0.001), had lower systolic blood pressure (P=0.040), had more painful manifestation (P<0.001), had more systematic complications [shock (P=0.001), coma (P<0.001), hypoxemia (P=0.006), kidney and liver dysfunctions, and myocardial injury (higher troponin, P=0.009)], and had worse blood coagulability [lower platelet count (P=0.012), longer prothrombin time (P<0.001), and higher D-dimer (P=0.003)]. Multivariable analysis identified the following independent risk factors: shock [odds ratio (OR): 8.12; 95% confidence interval (CI), 1.10-59.85, P=0.040], pain requiring medication (OR: 12.67; 95% CI, 2.43-66.09; P=0.003), troponin level >0.7 ng/mL (OR: 9.28; 95% CI, 1.72-50.06; P=0.010), and D-dimer level ≥10 µg/mL (OR: 13.37; 95% CI, 2.18-81.97; P=0.005).
Aortic rupture accounted for 47% of all in-hospital deaths among patient with ATAAD. Shock, pain requiring medication, a troponin level >0.7 ng/mL and a D-dimer level ≥10 µg/mL are independent risk factors for aortic rupture in these patients.
主动脉破裂是急性和亚急性 Stanford A 型主动脉夹层（ATAAD）患者早期死亡的主要原因之一。本研究旨在分析 ATAAD 患者术前主动脉破裂的潜在危险因素。
我们回顾性分析了 2013 年 5 月至 2016 年 5 月在上海长海医院接受治疗的主动脉夹层病例。最终纳入分析的 ATAAD 患者共 329 例，其中 31 例在手术前死于主动脉破裂。分析了所有 329 例患者的基本特征、临床表现及生化指标等临床资料。
院内主动脉破裂率为 9.4%（31/329），破裂占 ATAAD 患者院内死亡总数的 47%（31/66）。发生破裂的患者年龄显著更大（P<0.001），收缩压更低（P=0.040），疼痛表现更多（P<0.001），系统性并发症更多[休克（P=0.001）、昏迷（P<0.001）、低氧血症（P=0.006）、肝肾功不全及心肌损伤（肌钙蛋白更高，P=0.009）]，且凝血功能更差[血小板计数更低（P=0.012）、凝血酶原时间更长（P<0.001）、D - 二聚体更高（P=0.003）]。多变量分析确定了以下独立危险因素：休克[比值比（OR）：8.12；95%置信区间（CI），1.10 - 59.85，P=0.040]、需要药物治疗的疼痛（OR：12.67；95%CI，2.43 - 66.09；P=0.003）、肌钙蛋白水平>0.7 ng/mL（OR：9.28；95%CI，1.72 - 50.06；P=0.010）及 D - 二聚体水平≥10 µg/mL（OR：13.37；95%CI，2.18 - 81.97；P=0.005）。
主动脉破裂占 ATAAD 患者院内死亡总数的 47%。休克、需要药物治疗的疼痛、肌钙蛋白水平>0.7 ng/mL 及 D - 二聚体水平≥10 µg/mL 是这些患者主动脉破裂的独立危险因素。
