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目的回顾性分析2004—2014年间主动脉夹层患者院内死亡的相关危险因素,对治疗时机及治疗方案的选择进行探讨,以对临床治疗提供依据。方法回顾分析2004年1月—2014年1月期间在武汉同济医院住院的主动脉夹层患者1 037例的临床资料,将患者分为死亡组和存活组,比较两组患者的一般情况及分析死亡的相关危险因素。结果十年期间主动脉夹层院内死亡107例(10.32%),(53.23±10.37)岁,未死亡930例(89.68%),(53.59±11.81)岁。死亡患者入院到死亡的天数(4.17±1.65)d,Logistic回归分析示入院时低血压(P=0.047,OR=1.378,95%CI:1.654~2.171)、脉搏快(P=0.031,OR=1.321,95%CI:1.003~1.039)、心包积液(P=0.016,OR=2.031,95%CI:1.147~3.619)、白细胞计数(P=0.018,OR=1.281,95%CI:1.013~1.162)和中性粒细胞比值增高(P=0.011,OR=1.269,95%CI:1.028~1.119)是主动脉夹层死亡的独立危险因素,入院后使用β受体阻滞剂和ACEI药物是其保护因素,能减少主动脉夹层患者的院内死亡率。结论入院时低血压、脉搏快、心包积液、白细胞计数和中性粒细胞比值增高是主动脉夹层院内死亡的独立危险因素,入院后使用β受体阻滞剂和ACEI药物是主动脉夹层的保护因素。
Objective To retrospectively analyze the related risk factors of in-hospital mortality in patients with aortic dissection between 2004 and 2014, and to explore the timing of treatment and the choice of treatment options in order to provide evidence for clinical treatment. Methods The clinical data of 1 037 cases of aortic dissection hospitalized in Tongji Hospital of Wuhan from January 2004 to January 2014 were retrospectively analyzed. The patients were divided into death group and survival group. The general situation and mortality of the two groups were compared Related risk factors. Results During the 10 years, 107 cases (10.32%) died of in-hospital aortic dissection, (53.23 ± 10.37) years old, 930 cases (89.68%) did not die, (53.59 ± 11.81) years old. Logistic regression analysis showed that hospitalized hypotension (P = 0.047, OR = 1.378, 95% CI: 1.654-2.17 1), fast pulse (P = 0.031, OR = 1.321), the number of deaths from admission to death was 4.17 ± 1.65 days , 95% CI: 1.003-1.039), pericardial effusion (P = 0.016, OR = 2.031, 95% CI: 1.147-3.619) and white blood cell count (P = 0.018, OR = 1.281, 95% CI: And neutrophil ratio (P = 0.011, OR = 1.269, 95% CI: 1.028-1.19) were independent risk factors for death of aortic dissection. The use of β-blockers and ACEI after admission was a protective factor , Can reduce in-hospital mortality in patients with aortic dissection. Conclusions Hypotension, fast pulse, pericardial effusion, leukocyte count and neutrophil ratio on admission are the independent risk factors for in-hospital death of aortic dissection. The use of β-blockers and ACEI after admission is aortic dissection Protection factors.