目的 探讨糖尿病对主动脉壁内血肿的预后影响。 方法 纳入 2012 年 10 月至 2014 年 11 月我院连续 24 例主动脉壁内血肿患者，其中男 17 例、女 7 例，年龄（58.83±10.42）岁，定期复查主动脉 CTA（复查时间为 3～4 周），观察糖尿病患者和非糖尿病患者主动脉壁内血肿的进展情况。 结果 24 例患者在复查时，出现 A 型主动脉夹层 2 例，B 型主动脉夹层 3 例（均为腹部局限性夹层）；4 例患者合并糖尿病，复查时 2 例进展为主动脉夹层，2 例血肿及溃疡加重。 结论 主动脉壁内血肿整体呈吸收趋势，无并发症发生。手术事件的发生率与患者合并糖尿病有密切关系。
ObjectiveTo explore the early clinical outcomes of patients with acute type A aortic dissection and intramural hematoma.MethodsThe clinical data of 61 patients with acute type A aortic dissection or intramural hematoma in our hospital from January 23, 2020 to March 10, 2020 were retrospectively analyzed, including 43 males and 18 females, aged 22-81 (52.1±13.0) years. The patient's time of visit, clinical characteristics and early survival were analyzed. Kaplan-Mier survival curve and log-rank test were used for the survival analysis.ResultsThere were 48 (78.7%) patients diagnosed with acute type A aortic dissection and 13 (21.3%) patients with intramural hematoma; 34 patients received operation and 11 were emergent. The 30-day mortality was 2.9% among the patients receiving operation. There were 48 patients alive and 13 patients dead during the study period. The cumulative survival rates for all the patients on postoperative 1 day, 3 days and 7 days were 93.4%, 86.4% and 77.5%, respectively. The cumulative survival rates for the patients with dissection on postoperative 1 day, 3 days and 7 days were 95.7%, 88.7% and 79.4%, respectively. The cumulative survival rates for the patients with hematoma on postoperative 1 day, 3 days and 7 days were 92.3%, 84.6% and 84.6%, respectively. The difference of survival rates between the two groups was not statistically significant (P>0.05). The cumulative survival rate of all the patients on postoperative 14 days was 74.5%. No statistically significant difference in survival rate on postoperative 14 days was found between patients with intramural hematoma and patients with aortic dissection (P>0.05). The proportions of the patients with unstable hemodynamics were found statistically significant between the survival patients and the dead patients (P<0.05).ConclusionPatients with acute aortic dissection and intramural hematoma who survive to the hospital still have the risk of death under active drug therapy, and rupture of the dissection is the leading cause of death in these patients, especially for those with hemodynamic unstability.