Epidemiology and clinicopathology of aortic dissection -: A population-based longitudinal study over 27 years
Epidemiology and clinicopathology of aortic dissection -: A population-based longitudinal study over 27 years
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DOI：
10.1378/chest.117.5.1271
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发表时间：
2000-05-01
期刊：
影响因子：
9.6
通讯作者：
Szép, L
中科院分区：
文献类型：
--
作者：
Mészáros, I;Mórocz, J;Szép, L
研究目的：目的：探讨主动脉夹层的发病率和死亡率，分析其临床和病理变化。方法：对106，500例患者进行一项为期27年的纵向研究，包括66例住院患者和18例非住院患者。在84例患者中共发现86例主动脉夹层，对应于2.9/100，000/年的发病率。84例患者中有66例（79%）入院，18例（21%）在入院前死亡。年龄36 ~ 97岁，平均65.7岁。男女比例为1.55比1。入院后6 h内死亡率为22.7%，12 h内死亡率为33.3%，24 h内死亡率为50%，2 d内死亡率为88.2%。6例患者接受了手术，6例患者中有2例围手术期死亡，6例患者中有2例5年生存。所有未手术的患者均死亡。疼痛是最常见的初始症状。每个病人都有心血管和呼吸系统的症状。66例患者中有28例（42%）出现神经系统症状。5例表现为急腹症，2例表现为急性肾功能衰竭。80例尸检中，33例（41%）主动脉受累，69例（86%）主动脉破裂。在5例病例中，夹层也被发现自发愈合，近端/远端夹层的比例为5.1：1。所有18例院前病例均为急性。入院时急性夹层59例（89.4%），慢性夹层7例（10.6%）。高血压、高龄是主要的易感因素。84例患者中仅有13例（15%）的初始临床表现为主动脉夹层，因此，85%的患者未立即接受适当的药物治疗，因此，这些晚发现和/或未发现的病例可被视为未治疗或症状治疗组，其过程可能类似于主动脉夹层的自然过程。
Study objectives: To determine the incidence and mortality as well as to analyze the clinical and pathologic changes of aortic dissection.Design and setting: A population-based longitudinal study over 27 years on a study population of 106,500, including 66 hospitalized and 18 nonhospitalized consecutively observed patients.Measures: Analysis of data from the medical, surgical, and autopsy records of patients with aortic dissection,Results: Altogether, 86 cases of aortic dissection were found in 84 patients, corresponding to a 2.9/100,000/yr incidence. Sixty-six of the 84 patients (79%) were admitted to the hospital, and 18 patients (21%) died before admission. Their ages ranged from 36 to 97 years, with a mean of 65.7 years. The male/female ratio was 1.55 to 1. A total of 22.7% of the hospitalized patients died within the first 6 h, 33.3% within 12 h, 50% within 24 h, and 88.2% within the first 2 days after admission. Six patients were operated on, with a perioperative mortality of two of six patients and a 5-year survival of two of six patients. All patients who were not operated on died. Pain was the most frequent initial symptom. Every patient had some kind of cardiovascular and respiratory sign. Neurologic symptoms occurred in 28 of 66 patients (42%). Five patients presented with clinical pictures of acute abdomen and two with acute renal failure, Trunk arteries were affected in 33 of the 80 autopsied cases (41%), and rupture of aorta was seen in 69 cases (86%). In five cases, spontaneous healing of dissection was also found. The ratio of proximal/distal dissections was 5.1 to 1. All 18 prehospital cases were acute. Fifty-nine cases (89.4%) were acute at admission, and 7 cases (10.6%) were chronic dissections. Hypertension and advanced age were the major predisposing factors.Conclusion: Aortic dissection was the initial clinical impression in only 13 of the 84 patients (15%), Thus, 85% of the patients did not receive immediate appropriate medical treatment, For this reason, these late-recognized and/or unrecognized cases may be regarded as an untreated or symtomatically treated group, whose course may resemble the natural course of aortic dissection.