Siti Dilixiati, Abudesimu Asiya, Ma Xiaojie, Yang Lei, Ma Xiang, Ma Yi-Tong
1 Department of Cardiovascular Medicine, the First Affiliated Hospital of Xinjiang Medical University, Urumqi, China.
Vasa. 2018 Jun;47(4):301-310. doi: 10.1024/0301-1526/a000704. Epub 2018 May 29.
We investigated the prevalence of recurrent pain and its relationship with in-hospital mortality in acute aortic dissection (AAD).
Between 2011 and 2016, 234 AAD patients were selected. Recurrent pain was defined as a mean of VAS > 3, within 48 hours following hospital admission or before emergency operation. Patients with and without recurrent pain were divided into group I and group II, respectively into type A AAD and type B AAD patients. Our primary outcome was in-hospital mortality.
The incidence of recurrent pain was 24.4 % in AAD patients. Incidence of recurrent pain was higher in type A AAD patients than type B AAD patients (48.9 vs. 9.6 %). Overall in-hospital mortality was 25.6 %. Type A AAD had a higher in-hospital mortality than type B AAD patients (47.7 vs. 12.3 %). Group I had significantly higher in-hospital mortality than group II (type A: 79.1 vs. 17.8 %; type B: 57.1 vs. 7.6 %, all P < 0.001), as was the case with medical managed patients (type A: 72.1 vs. 13.3 %; type B: 35.7 vs. 2.3 %, all P < 0.001). Logistic regression analysis showed that use of one drug alone and waist pain were predictive factors for recurrent pain in type A AAD and type A AAD patients, respectively (OR 3.686, 95 % CI: 1.10312.316, P = 0.034 and OR 14.010, 95 % CI: 2.48179.103, P = 0.003). Recurrent pains were the risk factors (type A: OR 11.096, 95 % CI: 3.05740.280, P < 0.001; type B: OR 14.412, 95 % CI: 3.66256.723, P < 0.001), while invasive interventions were protective (type A: OR 0.133, 95 % CI: 0.0350.507, P < 0.001; type B: OR 0.334, 95 % CI: 0.1200.929, P = 0.036) for in-hospital mortality in AAD patients.
Approximately one-fourth of AAD patients presented with recurrent pains, which might increase in-hospital mortality. Thus, interventional strategies at early stages are important.
我们研究了急性主动脉夹层（AAD）患者中复发性疼痛的发生率及其与院内死亡率的关系。
选取2011年至2016年间的234例AAD患者。复发性疼痛定义为入院后48小时内或急诊手术前视觉模拟评分（VAS）平均值>3。有和无复发性疼痛的患者分别分为I组和II组，再分别分为A型AAD患者和B型AAD患者。我们的主要结局是院内死亡率。
AAD患者中复发性疼痛的发生率为24.4%。A型AAD患者复发性疼痛的发生率高于B型AAD患者（48.9%对9.6%）。总体院内死亡率为25.6%。A型AAD患者的院内死亡率高于B型AAD患者（47.7%对12.3%）。I组的院内死亡率显著高于II组（A型：79.1%对17.8%；B型：57.1%对7.6%，所有P<0.001），药物治疗的患者也是如此（A型：72.1%对13.3%；B型：35.7%对2.3%，所有P<0.001）。逻辑回归分析显示，单独使用一种药物和腰部疼痛分别是A型AAD和A型AAD患者复发性疼痛的预测因素（比值比[OR]3.686，95%置信区间[CI]：1.10312.316，P = 0.034；OR 14.010，95%CI：2.48179.103，P = 0.003）。复发性疼痛是危险因素（A型：OR 11.096，95%CI：3.05740.280，P<0.001；B型：OR 14.412，95%CI：3.66256.723，P<0.001），而侵入性干预对AAD患者的院内死亡率具有保护作用（A型：OR 0.133，95%CI：0.0350.507，P<0.001；B型：OR 0.334，95%CI：0.1200.929，P = 0.036）。
约四分之一的AAD患者出现复发性疼痛，这可能会增加院内死亡率。因此，早期的干预策略很重要。
