海拔高度对覆膜支架腔内隔绝术治疗B型主动脉夹层患者影像学变化及术后并发症的影响OA
Effect of altitude on imaging changes and postoperative complications in patients with type B aortic dissection undergoing thoracic endovascular aortic repair
目的 探讨海拔高度对覆膜支架腔内隔绝术治疗B型主动脉夹层患者影像学变化及术后并发症的影响.方法 选取2010年1月—2019年12月在青海省心脑血管病专科医院接受覆膜支架腔内隔绝术治疗的B型主动脉夹层患者200例,根据居住地海拔高度分为高原组100例和平原组100例.高原组和平原组分别为在海拔高度>3 000 m和≤3 000 m地区连续居住6个月及以上的患者.采用CT血管成像检查评估术后6个月、1年、3年的影像学指标.比较两组术后3年内并发症发生情况,并应用多因素Logistic回归分析影响并发症发生的危险因素.结果 高原组在术后6个月、1年和3年的真腔体积扩大率和假腔体积缩小率低于平原组,在术后6个月和1年的假腔内血栓化比率高于平原组(P<0.05).高原组术后3年内内漏、逆行性A型主动脉夹层、脑梗死发生率分别为12.00%(12/100)、10.00%(10/100)、15.00%(15/100),分别高于平原组的4.00%(4/100)、3.00%(3/100)、6.00%(6/100,P<0.05).海拔高度和年龄是B型主动脉夹层患者术后并发症发生的独立危险因素(P<0.05).结论 海拔高度显著影响B型主动脉夹层患者覆膜支架腔内隔绝术后的影像学变化和并发症发生风险.需更加关注高海拔地区患者的术后管理,以降低并发症发生率,提高预后.
Objective To investigate the effect of altitude on the imaging changes and postoperative complications of patients with type B aortic dissection(TBAD)undergoing thoracic endovascular aortic repair(TEVAR).Methods A total of 200 patients diagnosed with TBAD and treated with TEVAR at Qinghai Cardio-Cerebrovascular Hospital from January 2010 to December 2019 were selected.They were divided into the plateau group(n=100)and the plain area group(n=100)based on the altitude of their residence.The plateau group and the plain area group consisted of patients who had continuously resided in areas with an altitude greater than 3,000 meters and those with an altitude of 3,000 meters or less for at least 6 months.CT angiography was used to evaluate the imaging indicators at 6 months,1 year,and 3 years after the operation.The occurrence of complications within 3 years after the operation was compared between the two groups,and multivariate logistic regression analysis was applied to identify the risk factors influencing the occurrence of complications.Results The true lumen volume expansion rate and false lumen volume reduction rate of the plateau group were lower than those of the plain group at 6 months,1 year and 3 years after surgery,while the thrombosis rate of the false lumen was higher in the plateau group than in the plain group at 6 months and 1 year after surgery(P<0.05).The rates of endoleak,retrograde type A aortic dissection and cerebral infarction in the plateau group within 3 years after surgery were 12.00%(12/100),10.00%(10/100)and 15.00%(15/100),respectively,which were higher than those of the plain group[4.00%(4/100),3.00%(3/100)and 6.00%(6/100),P<0.05].Altitude and age were independent risk factors for the incidence of postoperative complications in patients with TBAD(P<0.05).Conclusion The altitude level significantly affects the imaging changes and the risk of complications in patients with TBAD after TEVAR.More attention should be paid to the postoperative management of patients in high-altitude areas to reduce the incidence of complications and improve prognosis.
赵名贤;李国杰
青海省心脑血管病专科医院血管外科,西宁 810000青海省心脑血管病专科医院血管外科,西宁 810000
B型主动脉夹层覆膜支架腔内隔绝术海拔高度影像学评估术后并发症危险因素
type B aortic dissectionthoracic endovascular aortic repairaltitudeimaging evaluationpostoperative complicationsrisk factor
《临床误诊误治》 2026 (11)
46-51,6
2022年青海省卫生健康系统指导性计划课题(2022-wjzdx-47)
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