老年合并急性主动脉综合征治疗方式的比较研究

刘鹏; 杨光

doi:10.13201/j.issn.1001-1439.2021.03.016

老年合并急性主动脉综合征治疗方式的比较研究

刘鹏,
杨光^,

- 大连医科大学附属第一医院心脏重症监护科(辽宁大连, 116001)

详细信息

通讯作者: 杨光,E-mail:yangguang740311@163.com

中图分类号: R543.1

收稿日期: 2020-07-26

修回日期: 2020-11-25

Comparative study on treatment strategies of elderly patients with acute aortic syndrome

LIU Peng,
YANG Guang^,

- Department of Cardiology Intensive Care Unit, the First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, 116001, China

More Information

Corresponding author: YANG Guang, E-mail: yangguang740311@163.com

Received Date: 26 July 2020

Revised Date: 25 November 2020

摘要

摘要: 目的:比较老年合并急性主动脉综合征(AAS)外科手术治疗及内科保守治疗的疗效与预后。方法:回顾性连续选取2014年5月—2018年5月我院收治的所有年龄>60岁的老年AAS患者311例,按治疗方式分为外科组及内科组,并分别对急性Stanford A型主动脉夹层组、急性Stanford B型主动脉夹层组、主动脉壁内血肿或溃疡组,以及60~69岁组、70~79岁组、>80岁组进行亚组分析。平均随访35.23个月,比较各组预后,研究终点为各种原因导致的临床死亡。结果:外科手术治疗可以改善老年AAS整体预后,外科组平均生存时间显著长于内科组[(50.00±2.04)个月∶(55.90±1.51)个月,P=0.001]。在Stanford A型主动脉夹层组中,外科组平均生存时间显著长于内科组[(35.64±5.34)个月∶(48.31±2.30)个月,P<0.001],院内病死率(46.9%∶8.3%,P<0.001)和院外病死率(25%∶8.3%,P=0.041)显著低于外科组。在Stanford B型主动脉夹层组中,外科组平均生存时间显著长于内科组[(43.96±3.59)个月∶(56.72±1.83)个月,P=0.003],院内病死率(10.6%∶1.9%,P=0.070)和院外病死率(27.7%∶5.8%,P=0.003)显著低于外科组。但在主动脉壁内血肿或溃疡组中,外科组与内科组预后相似。在年龄亚组中,外科手术可以改善60~69岁、70~79岁年龄组预后,但对于>80岁年龄组,两种治疗方式预后相似。结论:外科手术治疗可能改善60~79岁老年罹患急性主动脉夹层患者的预后,但对于主动脉壁内血肿及主动脉溃疡老年患者,内科保守治疗与外科手术治疗预后相似。
- 急性主动脉综合征 /
- 老年 /
- 外科治疗 /
- 内科治疗
Abstract: Objective: To compare surgical and medical treatment's efficacy and prognosis in elderly patients with acute aortic syndrome(AAS).Methods: A total of 311 AAS patients older than 60 years admitted in our hospital from May 2014 to May 2018 were retrospectively enrolled. All patients were divided into surgical group and medical group according to treatment methods. Each group was further divided into two kings of subgroups. The first subgroups included acute Stanford type A aortic dissection group, acute Stanford type B aortic dissection group, and aortic intramural hematoma or ulcer group. The second subgroups had 60-69-year-old group, 70-79-year-old group and >80-year-old group. We retrospectively analyzed all of the subgroups. The average follow-up time was 35.23 months, and the prognosis among each group was compared. The endpoint was clinical death caused by various reasons.Results: Surgical treatment improved the overall prognosis of elderly patients with AAS; the average survival time in the surgical group was significantly longer than that in the medical group([50.00±2.04]months vs [55.90±1.51]months, P=0.001). In the subgroup of Stanford type A aortic dissection, the average survival time in the surgical group was significantly longer than that in the medical group([35.64 ±5.34]months vs [48.31 ±2.30]months, P<0.001). The in-hospital mortality(46.9% vs 8.3%, P<0.001) and out-hospital mortality(25% vs 8.3%, P=0.041) were significantly lower than those in the surgical group. In the subgroup of Stanford B aortic dissection, the average survival time in the surgical group was significantly longer than that in the medical group([43.96 ±3.59]months vs [56.72 ±1.83]months, P=0.003), and the in-hospital mortality(10.6% vs 1.9%, P=0.070) and out-hospital mortality(27.7% vs 5.8%, P=0.003) were significantly lower than those in the surgical group. However, in the subgroup of intramural hematoma and aortic ulcer, surgical and medical treatment prognosis was similar. In the age subgroups, surgery improved the prognosis in the 60-69 and 70-79 age group, but for the >80 age group, the two treatments' prognosis was similar.Conclusion: Surgical treatment can significantly improve the overall prognosis of elderly patients with acute aortic dissection. Still, for elderly patients with intramural hematoma and aortic ulcers, the medical treatment prognosis is similar to surgical treatment.
- acute aortic syndrome /
- the elderly /
- surgical treatment /
- medical treatment

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