Objective To explore the effect of the anatomical location of the lesion on the prognosis and the subsequent treatment of type Stanford A acute aortic dissection surgery in patients combined with cerebral infarction.Methods The data of 657 patients who underwent type Stanford A acute aortic dissection surgery at Wuhan Asian Heart Hospital from January 2017 to December 2021 were collected.Among them,47 patients with new cerebral infarction were selected,and 5 patients with interventional thrombectomy were excluded.According to whether death at 90 days,the patients were divided into the death group and the survival group,and the influence of the anatomical characteristics of cerebral infarction on the prognosis of patients was analyzed.Results 42 patients were included.There were 13 cases(31％)in the death group and 29 cases(69％)in the survival group.The death group had a significantly higher NIHSS score(35 vs.8,P=0.001)and bilateral cerebral hemisphere involvement(69.2％vs.31.0％,P=0.021)than the survival group.Frontal,parietal and centrum semiovale were the mortality risk factors.Subgroup analysis of the cerebral infarction showed that there were 17 cases cerebral infarction occurred in the frontal lobe,of which 9 cases died and 8 cases survived.Compared with the survival group,the incidence of stroke was significantly higher in the death group with frontal cerebral infarction,and the stroke involved bilateral frontal(55.6％vs.0,P=0.029)and combined basal ganglia(33.3％vs.0,P=0.02),centrum semiovale(50.0％vs.6.3％,P=0.008)and occipital(50.0％vs.11.5％,P=0.03).The median time to death of cerebral infarction was 7 days and the lower quartile was 19 days.A Kaplan-Meier curve showed that the overall mortality during follow-up was 33.3％and the 90-day mortality rate of the stroke patients was 31.0％.Conclusions The risk of death is high when the NIHSS score is more than 16 points and the lesion involves both frontal lobes,or the frontal lesion is combined with the basal ganglia,centrum semiovale and occipital.7 days after stroke is the high-risk period of death;19 days basically pass the dangerous period,and the survival rate after discharge is good.
关键词
急性A型主动脉夹层/主动脉手术/脑梗塞/解剖学特征
Key words
Acute type A aortic dissection/Aortic surgery/Cerebral infarction/Anatomical features
维普
万方数据