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目的分析Stanford A型主动脉夹层年轻患者的临床特点。方法回顾性分析2004年3月至2011年6月解放军总医院行外科手术治疗的Stanford A型主动脉夹层患者54例的临床资料,以40岁为界将患者分为两组:年轻患者组23例,男17例,女6例;年龄(34.2±6.3)岁;对照组31例,男27例,女4例;年龄(51.5±6.8)岁。分析两组患者临床和手术治疗特点。结果两组患者术中体外循环时间[(224.4±83.1)min vs.(215.0±88.0)min,t=0.39,P=0.69]和主动脉阻断时间[(152.3±60.8)min vs.(130.9±51.2)min,t=1.34,P=0.18]差异无统计学意义。与对照组相比,年轻患者组中先天畸形(包括马方综合征及主动脉瓣二叶畸形)的发生率较高[34.7%(8/23)vs.6.4%(2/31),χ2=5.27,P=0.02],年轻患者术后精神及神经系统并发症明显较低[4.3%(1/23)vs.32.2%(10/31),χ2=5.32,P=0.02],而两组院内死亡率差异无统计学意义[13.0%(3/23)vs.12.9%(4/31),χ2=0.15,P=0.69]。结论年轻Stanford A型主动脉夹层患者中,心血管危险因素较少,而主要为先天性疾病,手术方式更积极,术后精神及神经系统并发症发生率较低。
Objective To analyze the clinical features of young patients with Stanford type A aortic dissection. Methods The clinical data of 54 patients with Stanford type A aortic dissection treated by PLA General Hospital from March 2004 to June 2011 were retrospectively analyzed. Patients aged 40 years were divided into two groups: young group 23 Cases, 17 males and 6 females; age (34.2 ± 6.3) years; control group of 31 patients, 27 males and 4 females; age (51.5 ± 6.8) years. Analysis of two groups of patients with clinical and surgical treatment characteristics. Results The duration of cardiopulmonary bypass was significantly lower in both groups (224.4 ± 83.1 min vs. 215.0 ± 88.0 min, t = 0.39, P = 0.69) and aortic cross-clamping time (152.3 ± 60.8 min vs. 130.9 ± 51.2) min, t = 1.34, P = 0.18] The difference was not statistically significant. Compared with the control group, the incidence of congenital malformations (including Marfan syndrome and aortic valve leaflet deformity) in young patients was higher (34.7% (8/23) vs.6.4% (2/31), χ2 = 5.27, P = 0.02]. The postoperative mental and neurologic complications were significantly lower in young patients [4.3% (1/23) vs.32.2% (10/31), χ2 = 5.32, P = 0.02] There was no significant difference in in-hospital mortality between the two groups (13.0% (3/23) vs. 12.9% (4/31), χ2 = 0.15, P = 0.69]. Conclusions Young Stanford type A patients with aortic dissection have fewer cardiovascular risk factors, mainly congenital diseases, more active surgical procedures, and lower postoperative psychiatric and neurologic complications.