| BackgroundAortic dissection (AD) is a life-threatening aortic disease. The emergency nature of this problem does not easily lend itself to study by randomized controlled trials, and there is little studies about aortic dissection in China.ObjectiveTo review the clinical traits, diagnosis method, misdiagnosis, risk factors and managements.MethodsAnalysis Parts of aortic dissection Patients admitted in our hospital between 2002 and 2008 retrospectively. All patients had medical records and got the post-treatments information by letters, telephone or clinic follow-up. Study the clinical traits, diagnosis method, misdiagnosis, risk factors and managements. All patients were typed according to Stanford criteria. Furthermore, compare the effect of medical treatment and surgery and endovascular repair. The statistics were analyzed with SPSS 16.0. Categorical variables were presented as frequencies and percentages, and the continuous variables were expressed as x±s. Univariate analyses between groups were done using chi-square cross tabulations for categorical data and the Student t test for continuous data. Relationships between the risk factors and follow-up deaths were investigated with multivariable Cox regression analysis. All P values were two-sided, with values<0.05 considered significant.ResultsNumber of type A was 105 and of type was 179. The mean age of type A was 48.92±11.39 and that of type B was 48.92±11.39. all of them were small then the number of IRAD(The International Registry of Acute Aortic Dissection)The percent of male Patients in the two types was about 80%. The percent of hypertension, artherosclerosis, Mafan's syndrome were not different between two types. The level of SBP of Type A group was lower then that of type B group. The percent of chest pain in type A group was higher than that of type B group and the percent of back and abdominal pain in type B group was higher than that of type A group.The percent of hydropericardium, pleural effusion, pulmonary infection, aortic incompetence, myocardial ischemia were different between two types. A history of atherosclerosis (HR,3.807; 95% CI,1.489 to 7.611; P=0.003), in-hospital hypotension/shock (HR,4.687; 95% CI,1.846 to 11.900; P=0.001), in-hospital myocardial ischemia or infarction (HR,3.734; 95% CI,1.613 to 8.643; P=0.002), pleural effusion (HR,2.210; 95% CI,1.080 to 4.521;P=0.030), branch vessel involvement (HR, 2.747; 95% CI,1.202 to 6.278;P=0.016) and surgical treatment (HR,0.177; 95% CI,0.063 to 0.502; P=0.001) were significant independent predictors of follow-up mortality for type A AD in Cox proportional hazards analysis, but insignificant independent predictors for type B AD (table 5). The total misdiagnosis rate was 6.34%,the misdiagnosis rate was 7.62% and 5.59% in type A group and type B group. Sixty-eight patients with type A AD and 174 patients with type B AD were followed-up with an average of 1277.6±724.27 days and 1356.0±773.31 days respectively. In type A group, the mortality was 49.25% and 14.29% in medical treatment group and surgery treatment group. In type B group, the mortality was 10.68% and 4.00% in medical treatment group and endovascular repair group.Conclusion1, Aortic dissection happened more frequently in 50 year old male people. A lot of patients usually present with chest and back pain. There was untypical symptom and misdiagnosis.2, The percents of patients with hypertension was high in both of two types of aortic dissection.3, The mortality was probable relate to the method, shock and artherosclerosis.4, The clinic traits, complications, method treatment and prognosis were different between two types aortic dissection.
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