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目的:总结女性Stanford B型主动脉夹层患者的临床特征。方法:2002-04-2010-10期间入住沈阳军区总医院并接受药物保守治疗或主动脉腔内隔绝术治疗的Stanford B型主动脉夹层患者,按性别分为女性患者组(72例)及男性患者组(173例)。对2组患者的临床特征及住院期间结果进行回顾性分析。结果:女性组和男性组平均年龄无差异,但女性组≥60岁比例高于男性组(37.5%∶24.9%,P<0.05)。男性组吸烟比例高于女性组(16.8%∶2.8%,P<0.05)。2组糖尿病、冠心病、血脂异常比例无差异。主动脉夹层病因包括高血压、动脉粥样硬化溃疡、外伤、马方综合征、多发性大动脉炎,2组病因构成无统计学差异。女性组从出现症状到就诊时间≥24h者比例高于男性组(81.9%∶68.2%,P<0.05)。临床症状:包括胸背部刀割样或撕裂样疼痛、腹痛、下肢疼痛、呼吸困难、咯血、晕厥,2组患者不同临床症状构成比例及伴发胸腔积血、肾功能不全比例无统计学差异,女性患者表现为突发疼痛比例低于男性患者(73.0%∶85.4%,P<0.05)。女性组心功能不全及低氧血症者比例高于男性组(11.1%∶4.0%,33.3%∶20.2%,均P<0.05)。女性组接受药物保守治疗的比例高于男性组(27.8%∶8.7%,P<0.05)。住院期间2组各死亡2例,接受主动脉腔内隔绝术及药物保守治疗者分别各死亡1例,均考虑夹层破裂死亡。住院期间不同性别组及各组内不同治疗方法间死亡率无统计学差异。结论:女性主动脉夹层患者老年比例高于男性,临床症状不典型,就诊较晚,需提高警惕,以免延误诊治。对有适应证的女性Stanford B型主动脉夹层患者建议施行主动脉腔内隔绝术治疗。
Objective: To summarize the clinical characteristics of female patients with Stanford type B aortic dissection. METHODS: Patients with Stanford type B aortic dissection admitted to Shenyang Military Region General Hospital from December 2002 to October 2010 with conservative medical treatment or aortic endovascular exclusion were divided into female patients (72 patients) and male patients Patient group (173 cases). The clinical characteristics of the two groups of patients and hospitalization during the retrospective analysis of the results. Results: There was no difference in average age between female and male groups, but the proportion of women aged 60 and older was higher than that of male (37.5% vs 24.9%, P <0.05). The smoking rate in males was higher than that in females (16.8% vs 2.8%, P <0.05). There was no difference between the two groups in diabetes, coronary heart disease and dyslipidemia. The causes of aortic dissection include hypertension, atherosclerotic ulcer, trauma, Marfan syndrome, and multiple arteritis. There was no significant difference in the cause of the two groups. The proportion of female patients from symptom onset to treatment ≥24h was higher than that of male patients (81.9%: 68.2%, P <0.05). Clinical symptoms include: incision-like or tearing-like pain in chest and back, abdominal pain, pain in lower extremity, dyspnea, hemoptysis and syncope. There was no significant difference in the proportions of different clinical symptoms and concomitant pleural hemorrhage and renal insufficiency among the two groups , Female patients showed a lower proportion of sudden pain than male patients (73.0%: 85.4%, P <0.05). Female patients with cardiac dysfunction and hypoxemia were higher than the proportion of male patients (11.1%: 4.0%, 33.3%: 20.2%, all P <0.05). Female patients receiving conservative treatment of drugs than the male group (27.8%: 8.7%, P <0.05). During the hospitalization, 2 patients died in each group. One patient died of dissection and the other died in the endovascular aortic excision and drug conservative treatment respectively. There were no significant differences in mortality between different sex groups and within different treatment groups during hospitalization. Conclusion: The proportion of elderly women with aortic dissection is higher than that of males. The clinical symptoms are not typical. Late treatment requires vigilance so as not to delay diagnosis and treatment. Aortic endovascular graft exclusion is recommended for indications of female patients with Stanford type B aortic dissection.