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《心脏杂志》[ISSN:1009-7236/CN:61-1268/R]

期数:

2011年第5期

页码:

643-646

栏目:

临床研究

出版日期:

2011-10-25

文章信息/Info

Title:

Clinical features and efficacy of endovascular intervention in elderly patients with Stanford B aortic dissection

作者:

孙鸣宇; 荆全民; 王效增; 王祖禄; 韩雅玲

沈阳军区总医院心内科、全军心血管病研究所，辽宁 沈阳 110016

Author(s):

SUN Ming-yu;  JING Quan-min;  WANG Xiao-zeng;  WANG Zu-lu;  HAN Ya-ling

Department of Cardiology, Shenyang General Hospital, & PLA Cardiovascular Research Institute, Shenyang 110016, Liaoning, China

关键词:

主动脉夹层; 腔内隔绝术; 动脉粥样硬化

Keywords:

aortic dissection;  endovascular intervention;  atherosclerosis

分类号:

R543.1

DOI:

-

文献标识码:

A

摘要:

目的:总结老年Stanford B型主动脉夹层患者的临床特征，分析老年患者施行腔内隔绝术的疗效及安全性。方法： 2002年4月~2010年10月入院并接受主动脉腔内隔绝术治疗的Stanford B型主动脉夹层患者210例，其中包括62例老年患者（老年组，年龄≥60岁）及148例非老年患者（非老年组，年龄<60岁）。对两组患者的临床特征、主动脉腔内隔绝术手术结果以及随访结果进行回顾性分析。结果： 老年组冠心病比例高于非老年组（P<0.01）。外伤、马方综合征、多发性大动脉炎均见于非老年组，动脉粥样硬化溃疡型夹层仅见于老年组，但两组病因构成无统计学差异。老年组以胸背部疼痛为表现者低于非老年组，以下肢疼痛和呼吸困难为表现及并发心功能不全者均高于非老年组（均P<0.01）。两组患者高血压病程、术前及术后最高收缩压、降压药种类数无统计学差异。非老年组术前及术后最高舒张压均高于老年组（P<0.05）。两组腔内隔绝术成功率均为100%。两组残余内漏、主动脉腔内隔绝术后综合征、切口感染发生率、院内死亡率无统计学差异。老年组术后胸背部疼痛发生率高于非老年组（P<0.01）。两组随访时间、总随访率、影像随访率、随访期间胸背部疼痛发生率、内漏发生率、截瘫发生率、血压控制不达标比例、主动脉夹层相关病死率无统计学差异。两组影像随访患者主动脉重构发生率均为100%。老年组全因病死率高于非老年组（P<0.05）。结论： 对于临床症状不典型的老年主动脉夹层患者需提高警惕，以免延误诊治。在有经验的中心对老年Stanford B型主动脉夹层患者施行主动脉腔内隔绝术治疗是安全而有效的。

Abstract:

AIM:To summarize the clinical features of elderly patients with Stanford B aortic dissection and to discuss the efficacy and safety of using endovascular intervention in these patients. METHODS: Clinical data and outcomes of endovascular intervention during hospitalization and follow-up were retrospectively analyzed in elderly patients (≥60 years, n=62) and younger patients (<60 years, n=148) who suffered from Stanford B aortic dissection and underwent endovascular intervention between April 2002 and October 2010. RESULTS: The proportion of patients with coronary artery diseases was higher in the elderly group than in the younger group (P<0.01). Trauma, Marfan’s syndrome and polyarteritis were seen in the younger group but penetrating atherosclerotic ulcer was seen only in the elderly group, with no statistical differences in etiology between groups. Chest/back pain was less described as a presentation in the elderly group than in the younger group, whereas lower limb pain, dyspnea and cardiac insufficiency were more often seen in the elderly group (P<0.01). No statistical difference was observed between groups in the course of hypertension, peaks of systolic pressure before and after stent-graft placement and types of hypotensive drugs. The peaks of diastolic pressure before and after endovascular intervention were higher in the younger group compared with those in the elderly population (P<0.05). The success ratios of endovascular therapy were both 100% in the two groups. No statistical differences were seen between groups in the incidences of endovascular leakage, postimplantation syndrome (transient elevations of body temperature and C-reactive protein and mild leukocytosis), incision infection and in-hospital mortality. Chest/back pain postintervention was more frequent in the group of elderly patients (P<0.01). No significant differences were observed between groups during the follow-up period, ratios of clinical and imaging follow-up and occurrence of chest/back pain, endovascular leakage, paraplegia, uncontrolled hypertension and mortality related to aortic dissection during follow-up. Aorta remodelings were seen in all patients who underwent computed tomography, magnetic resonance imaging or aortography during follow up. All-cause mortality in the elderly group was higher than in the younger group (P<0.05). CONCLUSION: To avoid delayed diagnosis and treatment, more attention should be given to the elderly population without classical symptoms of aortic dissection. It is safe and effective to treat elderly patients with Stanford B aortic dissection interventionally in centers with wide experiences.

参考文献/References

[1]Hagan PG,Nienaber CA,Isselbacher EM,et al.The International Registry of Acute Aortic Dissection (IRAD):new insights into an old disease[J].JAMA, 2000,283(7):897-903.

[2]Nienaber CA,Zannetti S,Barbieri B,et al.Investigation of stent grafts in patients with type B Aortic Dissection:design of the INSTEAD trial-a prospective,multicenter European randomized trial[J].Am Heart J,2005,149(4):592-599.

[3]Song TK,Donayre CE,Walot I,et al.Endograft exclusion of acute and chronic descending thoracic aortic dissections[J].J Vasc Surg,2006,43(2):247-258.

[4]Van Kodolitsh Y,Aydin MA,Loose R,et al.Predictors of aneurismal formation after surgical correction of aortic coarctation[J].Am Coll Cardiol,2002,39(4):617-624.

[5]Ward C.Clinical significance of the bicuspid aortic valve[J].Heart,2000,83(1):81-85.

[6]Akin I,Kische S, Ince H,et al.Indication,timing and results of endovascular treatment of type B dissection[J].Eur J Vasc Endovasc Surg,2009,37(3):289-296.

[7]Jing QM,Wang XZ,Di LH,et al.Endovascular stent-graft for type B aortic dissection in the elderly:comparing with younger patients[J].Journal of Geriatric Cardiology,2009,6(4):209-212.

[8]Genoni M,Paul M,Tavakoli R,et al.Predictors of complications in acute type B aortic dissection[J].Eur J Cardiothorac Surg,2002,22(1):59-63.

[9]Sueyoshi E,Sakamoto I,Hayashi K,et al.Growth rate of aortic diameter in patients with type B aortic dissection during the chronic phase[J].Circulation,2004,110(Suppl 1):II256-II261.

[10]Bortone AS,Schena S,D’Agostino D,et al.Immediate versus delayed endovascular treatment of post-traumatic aortic pseudoaneurysms and type B dissections: retrospective analysis and premises to the upcoming European trial[J].Circulation,2002,106(12suppl I):I234-I240.

[11]Ince H,Nienaber CA.The concept of interventional therapy in acute aortic syndrome[J].J Card Surg,2002,17(2):135-142.

备注/Memo

备注/Memo:

收稿日期：2010-12-09.通讯作者：韩雅玲，主任医师，主要从事冠心病介入治疗研究 Email：hanyal@mail.sy.ln.cn 作者简介：孙鸣宇，主治医师，硕士Email：sunmingyu1976@126.com

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更新日期/Last Update: 2011-11-03