Clinical Features Of Patients With Aortic Dissection And Risk Factors Related To Hospital Death

Objective:To investigate the risk factors,clinical features and nosocomial death related risk factors of aortic dissection(AD)patients with different debakey types.Methods: A retrospective analysis was made of 179 cases of patients admitted to the first affiliated hospital of new medical university from January 2013 to February 2014,and the aortic CTA was used to clearly diagnose the main artery dissection.The risk factors and clinical characteristics of the patients were analyzed according to the classification of debakey,and the influencing factors of hospital death in AD were analyzed by single factor and binary Logistic regression.Results: the age of patients with aortic dissection debakeyI,II and III showed statistical difference.The age of patients with type III AD was larger than that of patients with type I AD,with statistical significance(P < 0.05),and older than that of patients with type II AD,but there was no significant statistical difference(P > 0.05).Compared three groups of patients with risk factors,debakeyIII type history of hypertension,drinking is higher than in patients with AD debakeyI,type II patients,there is statistical significance difference(P < 0.05),debakeyI,type II marfan’s syndrome in patients with AD,two vane type expansion of aortic valve,aortic aneurysm and aortic valve closure is not complete merger rate is significantly higher than debakeyIII type,the difference was statistically significant(P < 0.05).There was no significant difference in smoking history,aortic surgery history and family history of aortic dissection between the three groups(P > 0.05).Among the 179 patients in this study,there were statistically significant differences among the three groups of patients(P < 0.05)in conservative internal medicine,stent interventional surgery,open surgery,and combination surgery.Patients with debakeyI type were given conservative internal medicine,accounting for 81.5%,while patients with debakeyIII type were given intracavity stent isolation,accounting for 67.6%.Using single factor and binary Logistic regression analysis the influence factors of AD in-hospital deaths: hospital death group and alive group in gender,age,smoking history,history of history,diabetes history of atherosclerosis,coronary heart disease,cerebrovascular disease,anemia,and pulmonary infection,pleural effusion,systolic pressure,diastolic blood pressure,heart rate,EF value,D-dimer,allergic C-reactive protein increases the incidence of pain,chest torn back sample etc is no significant difference(P > 0.05).The incidence of consciousness disturbance,hypotension/shock,dyslipidemia and pericardial effusion in the death group was significantly higher than that in the control group(P < 0.05).The incidence of hypertension was higher in the survival group than in the death group.In this study,35 patients died in the acute stage of main artery dissection,which was significantly different from the control group(P < 0.05).In this study,among the 35 patients with aortic dissection,debakeyI type accounted for 28 cases(80.0%),while debakeyII type and debakeyIII type only accounted for 4 cases(11.4%)and 3 cases(8.6%),with statistically significant difference in mortality(P < 0.05).The mean diameter of aortic sinus in the death group was larger than that in the survival group,and the difference was statistically significant(P < 0.05).The total hospitalization time and ICU residence time of the patients in the two groups were shorter than those in the survival group(P < 0.05).There were statistically significant differences in the treatment methods between the two groups.The survival group had more stent interventional surgery rate and open surgery rate than the death group,while the proportion of patients in the death group receiving conservative treatment alone was significantly higher than that in the survival group(P < 0.05).Multivariate logistic regression analysis indicated that the main influencing factors of nosocomial death in arterial dissection were the treatment method,stent interventional surgery and open surgery were protective factors,and the OR value of treatment method and nosocomial death [Exp(B)] was 0.362.Another factor influencing nosocomial death of main artery dissection by debakey classification,OR [Exp(B)],was 3.056,suggesting that type I aortic dissection was an independent risk factor for nosocomial death.Conclusions: 1)debakeyI,II,III,risk factors and clinical features of patients with aortic dissection: aortic dissection older debakeyIII type,high blood pressure consolidation rate higher,but,in contrast,small debakeyI,patients with type II AD age,risk factors in marfan’s syndrome,the vane expansion of aortic valve,aortic aneurysm and aortic valve closure is not complete merger rate is higher.2)comparison of death-related risk factors between the death group and the survival group: stenting interventional surgery and open surgery were protective factors,while type I aortic dissection and simple internal conservative treatment were independent risk factors for in-hospital death.