多层螺旋CT 血管造影表现对主动脉夹层患者 院内生存状况的影响

Effect of CTA imaging on in-hospital survival in patients with aortic dissection

摘要:

目的 探究多层螺旋CT 血管造影（CTA）对主动脉夹层患者院内生存状况的影响。方法 回 顾性分析2013 年1 月—2017 年12 月兴义市人民医院收治的63 例主动脉夹层患者的临床资料，患者均经多 层螺旋CTA 检查。8 例患者经介入手术治疗，55 例患者接受内科保守治疗，其中17 例患者住院期间死亡作 为死亡组，其余患者作为存活组。采用单因素和Logistic 多因素分析主动脉夹层患者多层螺旋CTA 影像学表 现与院内死亡的关系。结果 死亡组累分支血管数≥ 3、有胸腔积液、有心包积液、Stnford 分型为A 型、假 腔撕裂范围≥ 3 段发生率及平均总管腔增大均高于存活组（P <0.05）。受累分支血管数≥ 3[Ol ^ R=1.737，（95 CI ：2.397，4.184），P =0.024] 和假腔撕裂范围≥ 3 段[Ol ^ R=3.522，（95 CI ：2.025，3.987），P =0.019] 为主动脉 夹层患者院内死亡的危险因素。结论 多层螺旋CTA 能够显示主动脉夹层患者真假腔、内膜破口及血栓等 情况，具有较好的诊断价值和治疗参考价值，受累分支血管数≥ 3 和假腔撕裂范围≥ 3 段为主动脉夹层患者 院内死亡的相关因素，应加强对该类患者的监测，及时采取有效措施以改善院内生存状况。

Abstract:

Objective To investigate the effect of multislice CT angiography (CTA) on the in-hospital survival of patients with aortic dissection. Methods The clinical data of 63 patients with aortic dissection who were treated in our hospital from January 2013 to December 2017 were analyzed retrospectively. All the patients were examined by CTA. Eight patients were treated by interventional procedure and 55 patients received conservative medical treatment. Seventeen patients died during hospitalization as the death group and the rest as the survival group (n = 46). Univariate and Logistic multivariate analysis of the relationship between CTA imaging findings and hospital mortality in patients with aortic dissection. Results In the death group, the incidence of the number of affected branch vessels ≥3, pleural effusion, pericardial effusion, the Stanford classification A and false cavity tear ranges ≥3 were higher than those in survival group (P < 0.05). The results showed that the number of affected branch vessels ≥3 (Ol ^ R=1.737, 95% CI: 2.397, 4.184) and the false lumen tear ranges ≥3 (Ol ^ R=3.522, 95% CI: 2.025, 3.987) were influencing factors of hospital mortality in patients with aortic dissection (P < 0.05). Conclusions CTA images can show true and false lumen, intimal rupture and thrombus in patients with aortic dissection, which has good diagnostic value and reference value for treatment. The number of involved branches and blood vessels ≥3 and the false lumen tear ranges ≥3 were nosocomial death related factors in patients with artery dissection. Therefore, we should strengthen the monitoring of such patients and use timely and effective measures to improve the ho spital’s living conditions.