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目的观察他汀类药物对Stanford B型主动脉夹层患者行主动脉腔内修复术疗效的影响。方法回顾性分析2002年4月至2013年10月于沈阳军区总医院心血管内科住院治疗并行主动脉腔内修复术治疗的Stanford B型主动脉夹层患者388例,分析他汀组与非他汀组临床特点及主动脉腔内修复术后围手术期及3年随访的死亡率、再次行主动脉腔内修复术等事件的发生率。结果 (1)两组患者临床资料比较:两组患者的性别、年龄及体重指数等无统计学意义(P均>0.05);他汀组与非他汀组患糖尿病、脑卒中的比例无统计学意义(P均>0.05);他汀组高血压病、冠心病的比例明显高于非他汀组(P均<0.05);他汀组服用阿司匹林肠溶片的比例明显高于非他汀组(P<0.001);两组患者伴胸腔积液、心包积液的比例无统计学差异(P均>0.05)。(2)围手术期情况:两组患者植入支架的数目、长度、近远端直径及内漏的发生等差异均无统计学意义(P均>0.05);非他汀组完全封闭左锁骨下动脉的比例明显高于他汀组(P=0.020);两组患者围术期死亡、术后发热、脑卒中、肢体活动障碍及住院时间等差异均无统计学差异(P均>0.05);他汀组合并PCI的比例明显高于非他汀组(P<0.001)。(3)随访时间36个月,随访率为79.5%。随访期间两组患者死亡率、再次行主动脉腔内修复术、新发冠心病、脑卒中、截瘫等均无统计学差异(P均>0.05)。结论单中心研究未显示他汀类药物可以改善主动脉夹层患者行主动脉腔内修复术的近远期生存率。
Objective To investigate the effects of statins on the efficacy of endovascular aortic repair in patients with Stanford type B aortic dissection. Methods A retrospective analysis of 388 patients with Stanford type B aortic dissection treated with concurrent aortic endovascular repair in the Department of Cardiology, Shenyang Military Region General Hospital from April 2002 to October 2013 was performed. The clinical data of statin group and non-statin group Characteristics and aortic endovascular repair of perioperative and 3-year follow-up of the mortality rate, and again aortic endovascular repair and other events. Results (1) Comparison of clinical data between the two groups: The gender, age and body mass index of the two groups were not statistically significant (all P> 0.05). There was no significant difference between the statin group and the non-statin group in the incidence of diabetes and stroke (P> 0.05). The proportion of hypertension and coronary heart disease in statin group was significantly higher than that in non-statin group (all P <0.05). The proportion of aspirin enteric-coated tablets in statin group was significantly higher than that in non-statin group (P <0.001) There was no significant difference between the two groups with pleural effusion and pericardial effusion (P> 0.05). (2) Perioperative conditions: There was no significant difference in the number, length, diameter of proximal and distal ends and the incidence of endoleak between the two groups (all P> 0.05); the non-statin group completely closed the left subclavian Arterial ratio was significantly higher than the statin group (P = 0.020). There was no significant difference in perioperative mortality, postoperative fever, stroke, limb movement disorders and hospital stay between the two groups (P> 0.05) The proportion of combined PCI was significantly higher than non-statin group (P <0.001). (3) The follow-up time was 36 months and the follow-up rate was 79.5%. During the follow-up period, there was no significant difference in death rate, reoperation of aortic endovascular repair, new-onset coronary heart disease, stroke, paraplegia and so on (all P> 0.05). Conclusion Single-center studies have not shown that statins can improve near-to-long-term survival in patients undergoing endovascular aortic dissection with aortic dissection.