| Objective:By summarizing the clinical characteristics of patients with acute aortic syndrome,analyzing its risk factors,and discussing the treatment methods and prognosis,in order to improve the understanding of clinicians,especially emergency doctors,on this kind of disease,and minimize missed diagnosis and misdiagnosis,so as to avoid adverse consequences caused by delayed diagnosis and treatment.Method:In this study,382 patients with acute aortic syndrome,including aortic dissection,aortic intramural hematoma and penetrating atherosclerotic aortic ulcer,were selected from the cardiovascular disease diagnosis and treatment center of the first hospital of Jilin University from 2019 to 2020.The general data,clinical manifestations,complications,auxiliary examination,treatment and hospital outcome were analyzed retrospectively.Univariate analysis and binary logistic analysis were performed on the risk factors related to hospital outcome.Results:（1）According to Stanford classification,95 cases（24.87%）of type A,287 cases（75.13%）of type B,and incidence rate of type B were higher than that of type A.Among the three lesions of AD,IMH and PAU,the incidence rate of single lesion was the highest,and the incidence rate of AD was the highest（54.71%）,and the incidence of PAU was the lowest（3.93%）.There were two or three common diseases,among which IMH combined with PAU had a higher incidence rate（15.18%）.There were 257 males（67.28%）,125females（32.72%）,and the incidence rate of male was higher than that of female.The incidence rate was high in autumn and winter（56.02%）.Incidence rate was high（55.24%）at 50-70 years of age.In male patients,the youngest was 21 years old,the oldest was 87 years old,the average age of onset was（54.00±13.00）years old.In female patients,the youngest was 27 years old,the oldest was 82 years old,the average age of onset was（62.42±10.62）years old,and the age of onset of female was larger than that of male（P<0.05）.（2）In this study,254（66.49%）patients had previous history of hypertension,12（3.14%）had diabetes,132（34.55%）had smoking history,35（9.16%）had drinking history,29（7.59%）had history of aortic disease or family history,29 cases had rheumatic disease history,and there were traffic accidents and chest trauma history.293 patients（76.70%）had elevated blood pressure in varying degrees,of which 126 cases（32.98%）were mainly grade 3 hypertension.The blood pressure of 78 patients（20.42%）was normal.11 patients（2.88%）were in hypotension or shock.In addition,167 patients had limb blood pressure measurement,and 115 patients（68.86%）were abnormal.（3）In this study,366 patients（95.81%）had pain as the main manifestation.The other first manifestations were general fatigue,disturbance of consciousness,hemoptysis,hematemesis and black stool,abnormal limb sensation and movement,cerebral infarction,hoarseness,mandibular pain,elevated blood pressure,dyspnea,etc.Some patients had a variety of symptoms as the common primary manifestation.Among the patients with pain as the main manifestation,157 cases had unknown nature of pain,92 cases were tear,49 cases were wringing,23 cases were muggy,20 cases were knife cutting,and the rest showed severe,burning,swelling pain and acupuncture.There were 296 cases of chest pain,185 cases of back pain,66 cases of abdominal pain and 22 cases of waist pain.Among the complications,there were 152 cases of pleural effusion（39.79%）,115 cases of renal insufficiency（30.10%）,114 cases of aortic regurgitation or insufficiency（29.84%）,71 cases of pericardial effusion（18.59%）,45 cases of neurological complications（11.78%）,and other mediastinal effusion,hematoma and digestive system complications.（4）In this study,87.41%（243 / 278）of patients had elevated D-dimer,91.98%（218 /237）of patients had elevated CRP,and the proportion of elevated leukocyte count and neutrophil percentage was 75.66%（286 / 378）and 83.86%（317 / 378）.All 382 patients were diagnosed as AAS by CTA of thoracic and abdominal aorta.The detection rate of abnormal changes of aorta by echocardiography was 62.44%（138 / 221）.（5）In this study,132 cases（34.55%）only received conservative treatment.220 cases（57.59%）underwent endovascular interventional therapy,of which 3 cases were Stanford type A hematoma or ulcer lesions,and the other 217 cases were type B lesions.30 cases（7.85%）were treated with surgery,all of which were type A lesions.285 cases（74.61%）had improved condition and good hospital outcome,and 97 cases（25.39%）had poor hospital outcome,including 93 cases（24.35%）of unrehealed condition and 4 cases（1.04%）of hospital death.（6）In this study,the relative factors of different Stanford types were compared and analyzed.The results showed that the age of onset of type B was higher than that of type A.Blood pressure at admission,history of hypertension,history of diabetes and poor limb perfusion were more in type A than those in type B,and the difference was statistically significant（P < 0.05）.Hypotension or shock,abnormal blood pressure in limbs,renal insufficiency,pericardial effusion,neurological complications and abnormal echocardiography were more in type A than those in type B,and the difference was statistically significant（P < 0.05）.（7）The univariate analysis of relevant risk factors was carried out with in-hospital outcome as the dependent variable.The results showed that type A disease,hypotension or shock at admission,drinking history,aortic disease history or family history,renal insufficiency,pericardial effusion,neurological complications and no surgical treatment suggested poor in-hospital outcome of AAS patients,and the difference was statistically significant（P < 0.05）.Type A disease,neurological complications and no surgical treatment were independent risk factors for poor hospital outcome.Conclusions:（1）Three lesions of AAS can exist alone and both or all of them can coexist,and the incidence rate of simple AD is the highest.The incidence rate of Stanford type B is higher than that of type A.The incidence rate of male is higher than that of female,and the age of female is larger than that of male.AAS tends to occur in autumn and winter.（2）The clinical manifestations of AAS are complex and diverse,and the pain in the aortic shape area is the most common.Complications of multiple systems may occur,or related complications may be the first manifestation,which is very easy to be misdiagnosed and missed.Clinically,it is necessary to make a clear diagnosis as soon as possible in combination with auxiliary examination,so as to avoid serious consequences caused by delayed diagnosis and treatment.（3）Medical drug treatment is the basic treatment of AAS,and surgical treatment is the main means of AAS.Emergency open surgery is the first choice for type A lesions,and endovascular interventional therapy is the first choice for type B lesions.（4）The age of onset of Stanford type B was higher than that of type A.Blood pressure at admission,history of hypertension,history of diabetes and poor limb perfusion were more in type B than in type A.Hypotension or shock,abnormal blood pressure in limbs,renal insufficiency,pericardial effusion,neurological complications and abnormal echocardio-graphy were more in type A than in type B.（5）Stanford type A disease,hypotension or shock at admission,drinking history,history of aortic disease or family history,renal insufficiency,pericardial effusion,neurological complications and no surgical treatment suggest poor hospital outcome of AAS patients.Type A disease,neurological complications and no surgical treatment are independent risk factors. |
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