| Objective:This study is divided into three parts.Retrospectively analyzed a decade of hospitalized patients with aortic dissection epidemiological characteristics and clinical features in Tai’an area.To investigate the risk factors of aortic dissection in hospital death and blood biochemicalcharacteristics.In order to have a further understanding of aortic dissection, improve the level of diagnosis and treatment, reduce the misdiagnosis and, reduce the mortality rate.Methods:This study is divided into three parts were analyzed by retrospective studymethod:1. Retrospectively analyze the general condition,time of symptom onset,clinical signs and symptoms,diagnosis and delay in diagnosis,andtreatment. 2. Through the history data collection, analysis the relationship between age, sex, smoking, drinking history, history of disease, family history of cardiovascular disease, pathogenesis inducement, clinical symptoms and signs, the choice of treatment and the clinical case fatality rate of aortic dissection.3. Collecting 46 cases patients with aortic dissection diagnosed by imaging from 2011 to 2013 in Tai’an Central Hospital(aortic dissection group), including 25 cases of Stanford A aortic dissection, 21 cases of Stanford B aortic dissection; otherwise selecting 46 hypertension patients hospitalized in the same period as a control(hypertension group). Recording the first platelet, erythrocyte sedimentation rate, uric acid, D-dimer, fibrous protein, total cholesterol,triglycerides,low-density lipoprotein cholesterol(LDL-C), lipoprotein a, high-sensitivity C-reactive protein(hs CRP) after admission,serum creatinine, troponin I,homocysteine(HCY) levels. comparing the differences among the groups and study the relationship between partial peripheral blood biochemical markers and aortic dissection.Results:1.clinical analysis: Of the 232 cases,171 were male,61 female,with the age of( 58.21±12.24 mm),and there were 91 cases of type A,141 cases of type B.The incidence reach the highest in January,February,November and December.During the four months,cases of type A accounted for 51,65%,and type B for 53.90%.The incidence of chest pain,chest tightness,palpitations,syncope and unconsciousness was obviously higher in cases of type A than in those of type B( P<0.05).Back pain and abdominal pain were main symptoms in cases of type B,which was significantly different from those of type A( P<0.05).The incidence of hypotension,shock,bilateral asymmetric limb blood pressure,aortic diastolic murmur,pericardial effusion,cardiac tamponade,acute myocardial infarction,electrocardiogram changes and Marfan syndrome was higher in cases of type A than in those of type B.The difference was statistically significant( P<0.05).After medical treatment,78.02% got improved,16.38% died,5.60% showed no response and abandoned the treatment,11.21% were referred to the department of cardiosurgery for stent therapy,and 5.60% received surgical treatment.2.risk factors analysis: Through single factor analysis, history of hypertension,with or without hypertension, coronary atherosclerotic heart disease, hyperuricemia and hyperuricemia were aortic dissection disease risk factors. After unconditioned multiariable logistic regression analysis, classification, with or without hypertension, hypotension, or cardiac shock were risk factors for in-hospital death.3.research of the biomedical marker in peripheral blood:The results of uric acid, D- dimer, hs CRP, lipoprotein a, serum creatinine, homocysteine in aortic dissection group was significantly higher than the hypertension group [(380.39±141.50)mmol/L ratio(265.54±110.77)mmol/L、(724.50±727.12)mg/L ratio(249.98±325.58)mg/L、(31.21±34.91)mg/L ratio(11.33±8.68)mg/L、(280.48±116.19)mg/L ratio(202.46±124.64)mg/L、(89.13±16.86)umol/L ratio(81.15±19.03)umol/L、(15.74±11.87)umol/L ratio(11.92±3.49)umol/L](all P <0.01). Multivariate unconditional Logistic regression indicated that uric acid,hs CRP,hyperuricemia was an independent risk factor of aortic dissection.Conclusions:1. Aortic dissection typically occurred in patients aged 50~70 years,men were more likely to be affected than women,its peak onset mainly occurred in winter and spring,pain was the first sign and usually accompanied by pericardial effusion,abnormal blood pressure,syncope,and unconsciousness.CT,MRI,UCG and other imaging examination can greatly improve the accuracy of diagnosis.Accurate diagnosis,active medical treatment, and surgical and interventional therapy based on clinical classification can reduce mortality and improve the prognosis.2. A aortic dissection type, a history of hypertension, hypotension or cardiogenic shock which were the independent risk factors causing the death of patients with aortic dissection.Early diagnosis and proper treatment can improve the prognosis of patients with aortic dissection.3. Uric acid, hs CRP, hyperuricemia is closely correlated with aortic dissection. |
