| Objectives1.To investigate of clinical features of different Stanford-type aortic dissection(AD)patients.2.To investigate the influence of hypertension on the clinmcal features of AD.3.To explore the risk factors of hospitalization outcomes in patients with AD.MethodsA retrospective study was adopted.AD patients not less than 70 years old who were admitted to Qilu Hospital of Shandong University from January 2008 to December 2017 were involved in this study to analysis the clinical features and risk factors of hospitalization outcomes.The general clinical data were collected according to electronic medical records,including gender,age,admission date,emergency or outpatient,blood pressure and heart rate at admission,admission diagnosis,different Stanford type,length of hospital stay,past history,personal history,clinical symptoms,complications,imaging data,blood parameters at admission,treatment methods and clinical outcomes.According to the Stanford classification,they were divided into Stanford type A and Stanford type B.According to with hypertension or not,they were divided into hypertension group and non-hypertension group.According to the blood pressure at admission,they were divided into normal blood pressure group and high blood pressure group.According to the hospitalization outcome,they were divided into death group and survival group.The clinical data were analyzed by SPSS 21.0 software.The cont data were expressed by frequency and percentage,and the continuous data were described by mean ± standard deviation(x ± s).The numerical variables were tested by independent sample T test,and the categorical variables were cross-checked by chi-square test or Fisher’s exact test.A multivariate logistical regression analysis was performed to identify the odds radio and 95%CI after adjustment for confounding factors.For statistical evaluation,the p-value less than 0.05 was considered statistically significant between 2 groups.Results1.The total number of cases in the second five years is about three times that of the first five years,with an increase of 210%over the first five years.2.The ratio of Stanford A to Stanford B is 3.3:1.The ratio of male to female is 2.1:1.Male to female ratio of Stanford B is significantly higher than that of Stanford A.3.The onset of aortic dissection is seasonal,with November and December the highest rates two months.4.62.5%of patients were admitted to the hospital through emergency,especially Stanford A.5.72.6%of patients had hypertension.Compared with the non-hypertensive group,the mean levels of blood pressure,BUN,and UA were significantly higher in hypertension group.Patients of Stanford B are more likely to have coronary heart disease than Stanford A.There were no patients with Marfan syndrome of the 168 patients.6.Chest pain is the most typical clinical manifestation.Patients with chest pain and abdominal pain accounted for 70.2%and 19.6%respectively,and there was statistical difference between Stanford A and Stanford B.7.Ultrasound is still less commonly used in AD.8.Compared with Stanford B,the average level of NEU%is higher while HGB,HCT,and Cho is lower in Stanford B.9.62.5%of patients underwent surgery,with the surgery proportion of Stanford A significantly lower than that of Stanford B.The mortality rate during hospitalization was 13.8%,and there was statistically difference between the surgical group and conservative treatment group.10.The treatment,Stanford classification,NEU%,HCT and UA levels were different between the death group and the survival group significantly.ConclusionsHypertension is an important risk factor for the onset of AD.Atherosclerosis plays an important role in the development of senile AD,especially in Stanford B.Clinical application of bedside ultrasound should be popularized in AD,especially in patients with hemodynamic instability in the emergency department.For AD patients aged ≥ 70 years old,surgical intervention is superior to conservative treatment.Stanford A,NEU%,and UA are independent risk factors for hospitalization outcome. |
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