急性主動脈剝離患者分析：南臺灣某教學醫院之研究

The Study of Acute Aortic Dissection in a Teaching Hospital in Southern Taiwan

目的：分析急性主動脈剝離個案的流行病學，臨床表現，以及死亡個案的特點。方法：此研究方法為一橫斷式研究，時間自2004年7月1日至2008年12月31日止，於台灣南部某區域教學醫院，將急診患者的出院診斷中，有急性主動脈剝離者納入收案。病患的過去病史、臨床表現、理學檢查、診斷工具與住院結果將藉由病歷紀錄來收集。分析分成存活組與死亡組，比較兩者之間的差異。統計使用卡方檢定，獨立樣本t檢定及費歇恰當檢定。結果：共有68個案例，盛行率為每年每十萬急診人次28.7案例。其中A、B型各佔一半，整體死亡率為23.5%，而A型主動脈剝離且沒有手術介入者其死亡率為63.6%。進一步分析存活組與死亡組的比較，發現以下變項在死亡組顯著較高：年紀 ≥ 70歲、檢傷一級、A型主動脈剝離、慢性阻塞性肺病病史、到院時沒有任何疼痛表現的患者、有神經學徵兆（昏厥，急性意識改變，中風，肢體麻痺或癱瘓）、檢傷收縮壓＜120 mmHg、血紅素＜12 g/dL、影像學上有肋膜積液或電腦斷層上可以發現有頸動脈內膜瓣剝離的影響。結論：急性主動脈剝離在南台灣並非罕見，其臨床表現的確多變，也需要臨床醫師更高的警覺性。另外，了解死亡個案的特點，對於臨床醫師做決策上也有幫助。

Objectives: To analyze the epidemiology and clinical presentations of patients with acute aortic dissection (AAD), and evaluate the factors associated with mortality. Methods: The study was a retrospective cross-sectional one. Patients diagnosed with AAD at the time of discharge from the emergency department of a teaching hospital in Southern Taiwan from July 1, 2004 to December 31, 2008 were enrolled. Data about past history, clinical presentation, physical findings, methods of diagnosis, and in-hospital outcome were collected from medical records. We compared those who survived and those who did not. Our statistical methods were Chi-Square tests, Independent t tests, and Fisher's Exact tests. Results: There were 68 cases of AAD and the prevalence was 28.7 per 100,000 cases per year. The numbers of Types A and B AAD were the same. The total mortality rate was 23.5%, and the mortality in patients with type A dissection without surgical intervention was 63.6%. The comparison between groups showed the following variables to be more characteristic of the group that did not survive: age ≥ 70, triage level one, type A dissection, past history of COPD, painless presentation on arrival, neurologic signs (syncope, acute altered mental status, stroke, paralysis or paraplegia), systolic blood pressure ＜120 mmHg, hemoglobin level ＜12 g/dL, and image findings of any pleural effusion or intimal tear of the carotid artery found on computerized tomography. Conclusions: Acute aortic dissection is not rare in Southern Taiwan and its presentation is variable. Physicians should be more aware of it and understand the characteristics associated with mortality in order to make proper clinical judgments.