Clinical Characteristics Of 53 Patients With Different Types Of Aortic Dissection In Hangzhou Area

ObjectiveBy analyzing the clinical data of patients with aortic dissection(AD)admitted to our hospital in a certain period,the clinical characteristics of AD were summarized in order to enhance the understanding of the disease and provide help for clinical diagnosis,treatment and prevention.MethodsThe general data,clinical manifestations,laboratory tests,electrocardiogram(ECG)and imaging examinations,diagnosis and misdiagnoses,treatments,prognoses of patients with AD admitted to our hospital from January 2015 to September 2018 were analyzed retrospectively.ResultsThe clinical data of 53 patients with AD were collected,including 39 males and14 females.The ratio of males-females was 2.8:1,and an average age of(56.45±18.65)years.According to Stanford system,26 cases were classified as type A group and 27 cases as type B group.In terms of clinical manifestations,thoracodorsal pain accounted for a high proportion in both group A and group B,accounting for 76.9%and 81.5%,respectively.It was also found that the proportion of hypotension(<90/60 mmHg)in patients with Stanford type A was higher than in patients with type B,while the proportion of hypertension(systolic blood pressure ?140mmHg and(or)diastolic blood pressure?90 mmHg)in patients with type B was higher than that in patients with type A(P=0.008).In laboratory examinations,the levels of D-dimer,prothrombin time and creatinine in type A patients were higher than those patients with type B(P<0.05),and the proportion of troponin I>0.012 mg/ml in patients with type A was higher than that in patients with type B(P=0.004).In ECG and imaging examinations,it was found that the incidence of ST segment or T wave changes in Stanford A patients was higher than that in patients with type B(P=0.011),and the internal diameter of ascending aorta in patients with type A was largerthan that in patients with type B(P=0.015).However,the incidences of normal ECG,pleural reaction and the left ventricular diastolic function reduction in patients with type B were higher than that in patients with type A(P<0.05).In this study,42 cases were initially diagnosed as AD,and 11 cases were misdiagnosed or delayed diagnosis.66.0% of patients with AD were diagnosed by transthoracic echocardiography,and the diagnostic rate of type A dissection was higher than that of type B dissection.The overall diagnostic rate of computed tomography angiography for AD was 91.8%.Among the 53 AD patients,21 cases were treated with drugs alone,17 cases were treated with interventional surgery,15 cases were treated with open surgery.Statistically,there were 19 cases died during hospitalization.The total mortality rate of patients with Stanford type A was higher than that of patients with type B(P=0.035).Through logistic regression analysis,females and D-dimer were screened out as the risk factors of death for AD in hospitalization.Women were 30.329 times more likely to die from AD than men.And each unit increase in D-dimer was associated with a 27.8% increase in the risk of death in patients with AD.ConclusionSudden onset of severe thoracodorsal pain was the most common symptom of AD.The incidence of hypotension on admission in patients with Stanford type A was higher than that in patients with type B,while the incidence of hypertension in patients with type B was higher than that in patients with type A.Computed tomography angiography was of great significance in the clinical diagnosis of AD.The mortality rate of AD was high,and the mortality rate of patients with type A was higher than that of patients with type B.Female and d-dimer were the new risk factors for hospitalized death of AD.