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目的探讨A型急性主动脉夹层患者入院时收缩压水平对住院死亡风险的影响。方法研究对象为2008年至2010年到阜外医院就诊经主动脉CT证实诊断为Stanford A型急性主动脉夹层患者共595例,收集患者的基线资料、入院时血压水平、治疗策略及其住院死亡情况。按患者入院时收缩压水平分为四组,比较住院死亡率及其影响因素。结果血压降低组(收缩压<90mmHg)的住院死亡率显著高于正常血压组(90mmHg≤收缩压<140mmHg)和血压轻度增高(140mmHg≤收缩压<160mmHg)及显著增高组(收缩压≥160mmHg)(45%vs.8.5%vs.9.7%vs.14.5%,P<0.05)。接受外科手术治疗患者中,血压降低组与其他组比较住院死亡率无显著差异(0%vs.0.5%,P>0.05),药物保守治疗患者中血压降低组住院死亡率显著高于其他组(81.8%vs.31%,P<0.05)。经多因素COX生存分析校正年龄和性别等因素后,入院时收缩压降低增加2.35倍的住院死亡危险(HR 2.35,95%CI 1.14-4.87,P=0.031),住院死亡的独立影响因素还包括基线血肌酐水平、白细胞计数、血小板计数及是否接受外科治疗。结论 A型主动脉夹层患者入院时的收缩压水平低于90mmHg时接受药物保守治疗的院内死亡风险较高,应尽早考虑接受外科手术治疗改善预后。
Objective To investigate the effect of systolic blood pressure (SBP) on the risk of hospital mortality in patients with type A acute aortic dissection. Methods A total of 595 patients diagnosed with Stanford type A acute aortic dissection were enrolled in Fu Wai Hospital from 2008 to 2010. A total of 595 patients were enrolled in this study. Baseline data, blood pressure level at hospital admission, treatment strategy and hospitalization were collected Happening. Symptomatic systolic blood pressure by admission were divided into four groups, compared with hospital mortality and its influencing factors. Results In-hospital mortality was significantly higher in patients with hypotension (systolic blood pressure <90 mmHg) than in patients with normal blood pressure (90 mmHg ≤ systolic blood pressure <140 mmHg) and mild increase in blood pressure (140 mmHg ≤ systolic pressure <160 mmHg) and significantly higher systolic blood pressure ≥ 160 mmHg ) (45% vs.8.5% vs.9.7% vs.14.5%, P <0.05). In hospitalized patients, there was no significant difference in in-hospital mortality between the hypotensive group and other groups (0% vs.0.5%, P> 0.05). In-hospital mortality was significantly higher in patients with conservative hypotension than in other groups 81.8% vs.31%, P <0.05). After adjusted for age and gender by multivariate COX survival analysis, the reduction of systolic blood pressure at hospital admission increased the risk of hospitalization by 2.35 times (HR 2.35, 95% CI 1.14-4.87, P = 0.031) and independent factors of in-hospital mortality Baseline serum creatinine, white blood cell count, platelet count and whether to undergo surgical treatment. Conclusions Patients with type A aortic dissection have a higher risk of nosocomial death if their systolic blood pressure at admission is lower than 90 mmHg. Prognosis should be considered as soon as possible after surgical treatment.