摘要
目的比较胸主动脉腔内修复术(TEVAR)治疗急性主动脉穿透性溃疡(PAU)伴壁内血肿(IMH)与急性Stanford B型主动脉夹层(ATBAD)的临床效果。方法选取北部战区总医院自2013年3月至2021年12月收治的明确诊断为主动脉扩张性疾病并行TEVAR的589例患者为研究对象,并分别纳入PAU+IMH组(n=66)和ATBAD组(n=523)。采用倾向性评分进行两组匹配(1∶1),比较两组患者的临床资料,以及在院期间和远期临床不良事件的发生情况。结果匹配前:PAU+IMH组年龄、血小板计数、C反应蛋白及合并吸烟史、合并冠心病史、合并脑血管病史比例均高于ATBAD组,体质量指数、入院收缩压、入院舒张压、白细胞计数均低于ATBAD组,差异有统计学意义(P<0.05);两组影像学和手术特征比较,差异均无统计学意义(P>0.05)。匹配后:两组基线资料、影像学和手术特征比较,差异均无统计学意义(P>0.05)。匹配前后,两组在院期间临床不良事件发生率和住院时间比较,差异均无统计学意义(P>0.05)。平均随访48个月,PAU+IMH组随访61例(92.4%,61/66),ATBAD组随访500例(95.6%,500/523)。匹配前,PAU+IMH组全因死亡、主动脉源性死亡发生率均高于ATBAD组,差异有统计学意义(P<0.05);匹配后,两组远期临床不良事件发生率比较,差异均无统计学意义(P>0.05)。匹配前,PAU+IMH组存活率低于ATBAD组,主动脉源性死亡率高于ATBAD组,差异均有统计学意义(P<0.05);匹配后,两组存活率和主动脉源性死亡率比较,差异均无统计学意义(P>0.05)。匹配前:接受TEVAR 2年内,两组主动脉源性死亡率比较,差异无统计学意义(P>0.05);2年后,PAU+IMH组主动脉源性死亡率高于ATBAD组,差异有统计学意义(P<0.05)。匹配后:接受TEVAR 2年内和2年后,两组主动脉源性死亡率比较,差异均无统计学意义(P>0.05)。结论急性PAU伴IMH患者行TEVAR安全有效,与ATBAD患者行TEVAR相比,其TEVAR 2年后的主动脉源性死亡明显增加,需加强此类患者的长期管理以改善预后。
Objective To compare the clinical efficacy of thoracic endovascular repair(TEVAR)in the treatment of acute penetrating thoracic aortic ulcer(PAU)with intramural hematoma(IMH)and acute stanford type B aortic dissection(ATBAD).Methods A total of 589 patients with dilated aortic artery disease and TEVAR admitted to General Hospital of Northern Theater Command from March 2013 to December 2021 were selected as the research objects,and were included in PAU+IMH group(n=66)and ATBAD group(n=523),respectively.The propensity score was used to match the two groups(1∶1),and the clinical data,in-hospital and long-term clinical adverse events were compared between the two groups.Results Before matching,the age,platelet count,C-reactive protein,the proportion of smoking history,coronary heart disease history and cerebrovascular history in PAU+IMH group were higher than those in ATBAD group,and the body mass index,systolic blood pressure on admission,diastolic blood pressure on admission and white blood cell count were lower than those in ATBAD group,and the differences were statistically significant(P<0.05).Before matching,there was no significant difference in imaging and surgical characteristics between the two groups(P>0.05).After matching,there was no significant difference in baseline data,imaging and surgical characteristics between the two groups(P>0.05).There was no significant difference in the incidence of clinical adverse events and length of hospital stay between the two groups before and after matching(P>0.05).Sixty-one patients(92.4%,61/66)in the PAU+IMH group and 500 patients(95.6%,500/523)in the ATBAD group were followed up for an average of 48 months.Before matching,the incidences of all-cause death and aortic origin death in PAU+IMH group were higher than those in ATBAD group,and the differences were statistically significant(P<0.05).After matching,there was no significant difference in the incidence of long-term clinical adverse events between the two groups(P>0.05).Before matching,the survival rate of PAU+IMH group was lower than that of ATBAD group,and the aortogenic mortality rate was higher than that of ATBAD group,and the differences were statistically significant(P<0.05).After matching,there was no significant difference in survival rate and aortogenic mortality between the two groups(P>0.05).Before matching:within 2 years after receiving TEVAR,there was no significant difference in aortogenic mortality between the two groups(P>0.05);after 2 years,the aortogenic mortality of PAU+IMH group was higher than that of ATBAD group,and the difference was statistically significant(P<0.05).After matching:there was no significant difference in aortogenic mortality between the two groups within 2 years and 2 years after receiving TEVAR(P>0.05).Conclusion TEVAR is safe and effective in patients with acute PAU and IMH.Compared with patients with ATBAD,TEVAR is associated with a significant increase in aortic death after 2 years of TEVAR.Long-term management of these patients should be strengthened to improve the prognosis.
作者
祁俊仙
张志强
周铁楠
王亚松
王效增
祝焕林
QI Jun-xian;ZHANG Zhi-qiang;ZHOU Tie-nan;WANG Ya-song;WANG Xiao-zeng;ZHU Huan-lin(Department of Cardiology,General Hospital of Northern Theater Command,Shenyang 110016,China;Department of Cardiology,No.968 Hospital of PLA,Jinzhou 121000,China)
出处
《临床军医杂志》
CAS
2022年第10期1023-1029,共7页
Clinical Journal of Medical Officers
基金
辽宁省“兴辽英才计划”资助项目(XLYC2008004)
作者简介
第一作者:祁俊仙(1983-),女,辽宁本溪人,主治医师,硕士;通信作者:王效增,E-mail:wxiaozeng@163.com;通信作者:祝焕林,E-mail:zhu66333@163.com
