A型主动脉夹层患者术前猝死相关因素分析三峡大学人民医院&amP;宜昌市第一人民医院心胸外科湖北宜昌邮编：443000作者简介：李奎（1982.05-），男，汉族，湖北宜昌人，主治医师，外科学硕士，研究方向：心血管外科、胸外科。［摘要］目的：探讨A型主动脉夹层患者术前猝死的危险因素，指导临床实践。方法：调取2010年10月-2015年10月期间我科收治的48例超声心动图和增强CT明确显示升主动脉受累的A型主动脉夾层患者资料，其中10例术前猝死，作为实验组；其余38例未发生术前猝死，作为对照组。摘录患者的一般资料、身体质量指数（BMI）、血脂相关生化指标、超声心动图等数据，查阅相关文献，列出与A型主动脉夹层术前猝死关系密切的变量。先将各变量用单因素分析以P<0.25为标准进行筛选，将筛选出的变量进一步用多因素Logistic回归分析得出危险因素。结果：单因素分析显示：以P<0.25为标准，筛选进入多因素Logistic回归分析的变量有BMI、血清总胆固醇、夹层累及主动脉窦部及假腔血栓化四个因素。进一步多因素Logistic回归分析显示：其中，BMI和夹层累及主动脉窦部两个因素与A型主动脉夹层患者术前猝死呈正相关,而假腔血栓化与术前猝死呈负相关趋势。结论：临床医师在A型主动脉夹层患者的救治中应快速准确评估BMI、夾层累及主动脉窦部及假腔血栓化等因素，并选择合适的手术方案和最佳手术时机。关键词：A型主动脉夹层；术前猝死；危险因素【中图分类号】R423【文献标识码】A【文章编号】1001-5213（2016）08-0267-01AnalysisofRelatedFactorsofPreoperativeSuddenDeathinPatientswithTypeAAorticDissectionLikui,ZhangYulin(DepartmentofCardiothoracicSurgery，RenminHospitalofThreeGorgesUniversity&TheFirstPeople'sHospitalofYichang，丫ichang,Hubei,443000)[abstract]objective:tostudythetypeAaorticdissectioninpatientswithpreoperativeriskfactorsofsuddendeath,toguideclinicalpractice.Methods:inOctober2010-tobeobtainedinOctober2015of48casesadmittedinourdepartmentduringechocardiographicandenhancedCTclearlyshowtheascendingaortainpatientswithtypeAaorticdissection,including10casesofpreoperativedeath,astheexperimentalgroup;Theremaining38casesofpreoperativedeathnotoccurring,ascontrolgroup.Excerptsfromthepatient'sgeneralinformation,bodymassindex(BMI),bloodlipidrelatedbiochemicalindicators,suchasechocardiographydata,consultingrelevantliterature,listandtypeAaorticdissectionpreoperativevariablescloselyrelatedtosuddendeath.ToeachvariablewithsinglefactoranalysiswithP<0.25forthestandardscreening,willfilteroutvariablesusingmultiariableLogisticregressionanalysisfurtherriskfactors.Results:singlefactoranalysisshowedthat:withP<0.25forthestandard,filterintothemulti-factorLogisticregressionanalysisofvariablewithBMI,serumtotalcholesterol,dissectioninvolvingtheaorticsinusandfalselumenthrombosisfourfactors.FurthermultiariableLogisticregressionanalysisshowedthat:amongthem,thedepartmentofBMIanddissectioninvolvingtheaorticsinustwofactorsandtypeApreoperativesuddendeathinpatientswithaorticdissectionwerepositivelycorrelated,andthefalselumenthrombosisandnegativelycorrelatedwithpreoperativedeathtrend.Conclusion:clinicalphysiciansinthetreatmentofpatientswithtypeAaorticdissectionshouldbefastaccurateevaluationofBMI,dissectioninvolvingtheaorticsinusandfalselumenthrombosisandotherfactors,andchoosingappropriatesurgicalplanandtheoptimaltimingofsurgery.Keywords:typeAaorticdissection;Preoperativedeath;Riskfactorsfor累及升主动脉的StanfordA型主动脉夹层是各型主动脉夹层中最为凶险的一型，因其病变部位靠近冠状动脉开口处，极易导致急性心肌人面积梗死[1],迅速进展，易发生猝死，0前外科手术为其最佳治疗方法［2】，但术前猝死的发生率极高。本文旨在分析A型主动脉夹层...