目的 探讨64层螺旋CT三维重建技术在主动脉夹层介入术前评估中的价值。方法 选择2023年7月—2024年5月在潜江市中心医院诊治的主动脉夹层疑似患者96例为研究对象,所有患者均进行64层螺旋CT三维重建技术检查, 记录成像参数。所有患者在64层螺旋CT三维重建后进行介入治疗, 以介入检查结果为金标准, 判断64层螺旋CT三维重建技术在主动脉夹层介入术前评估中的价值。结果 在96例患者中, 64层螺旋CT三维重建联合判断为主动脉夹层60例, 其中Ⅰ型32例、Ⅱ型20例、Ⅲ型8例,其中再现（VR）、最大密度投影（MIP）及多平面重建（MPR）分别判断为主动脉夹层56例、54例、56例。在96例患者中, 64层螺旋CT三维重建检查的破口层面主动脉平均直径（3.08±0.25）cm、破口至左锁骨下平均距离（4.05±0.26）cm, 与介入治疗检查（3.05±0.36）cm、（4.06±0.14）cm, 对比差异无统计学意义（t=0.671, P=0.503; t=0.332, P=0.740）。64层螺旋CT三维重建联合、VR、MIP、MPR对主动脉夹层的诊断灵敏度分别为98.33%、93.22%、89.83%、94.92%, 特异度分别为97.30%、97.30%、97.30%、100.00%, 准确率分别为98.96%、94.79%、92.71%、96.88%。结论 64层螺旋CT三维重建技术在主动脉夹层介入术前评估中具有很高的灵敏度、特异度与准确率。

Objective To explore and analyze the value of 64-slice spiral CT three-dimensional reconstruction technology in the preoperative assessment of aortic dissection（AD）intervention．Methods From July 2023 to May 2024, 96 cases of patients suspected of aortic dissection treated in our hospital were selected as the research subjects．All patients underwent 64-slice spiral CT three-dimensional reconstruction technology examination, and imaging parameters were recorded．After the 64-slice spiral CT three-dimensional reconstruction, all patients were given interventional treatment, and the results of the interventional examination were used as the “gold standard” to evaluate the value of 64-slice spiral CT three-dimensional reconstruction technology in the preoperative assessment of aortic dissection intervention．Results Among the 96 patients,64-slice spiral CT three-dimensional reconstruction combined diagnosis identified 60 cases of aortic dissection,including 32 type I, 20 type II, and 8 type III cases．volume rendering（VR）, maximum intensity projection（MIP）, and muhiplanar reconstrudion（MPR） identified 56, 54, and 56 cases of aortic dissection,respectively．In 96 patients, the mean aortic diameter at the lacerated level and the mean distance from the lacerated to the left subclavicular level were（3.08±0.25）cm and（4.05±0.26）cm respectively in 64-slice spiral CT three-dimensional reconstruction examination, compared with（3.05±0.36）cm and（4.06±0.14）cm in interventional examination．There was no difference in comparison（t=0.671, P=0.503; t=0.332, P=0.740）．The sensitivity, specificity, and accuracy of the 64-slice spiral CT three-dimensional reconstruction combined, VR, MIP, and MPR for the diagnosis of aortic dissection were 98.33%, 93.22%, 89.83%, 94.92%, specificity were 97.30%, 97.30%, 97.30%, 100%, accuracy were 98.96%, 94.79%, 92.71%, 96.88%．Conclusions Technology of 64-slice spiral CT three-dimensional reconstruction has high sensitivity, specificity, and accuracy in the preoperative assessment of aortic dissection intervention and is worth promoting and applying clinically．

目的 构建并验证主动脉夹层B型（TBAD）患者急性期预后的列线图预测模型,帮助临床医生在急性期内更准确地评估TBAD患者的死亡风险,并制定更合适的治疗策略。方法 回顾性分析从重症监护医学信息数据库v2.2 中提取的399例 TBAD患者的人口学资料和临床资料,结局为TBAD患者急性期（≤14 d）内死亡。先采用最小绝对收缩选择算法回归筛选特征变量,再采用多因素分析确定独立预后因素,并据此构建预测模型。通过受试者工作特征曲线、校准曲线、决策曲线分析（DCA）评价列线图预测模型的性能和临床适用性。结果 APS Ⅲ评分、二氧化碳总量、红细胞分布宽度为TBAD患者14 d内死亡的独立预测因素。列线图预测模型在内部验证中的受试者工作特征曲线下面积为0.776（95% CI：0.691 ~ 0.860）,Hosmer-Lemeshow 检验P=0.604,校准曲线和标准曲线高度重合,表明该模型具有良好的区分度和校准度。同时,DCA曲线显示,预测模型在大部分的阈值概率范围内提供了显著的净收益。结论 本研究基于APS Ⅲ评分、二氧化碳总量、红细胞分布宽度构建的列线图预测模型可以较准确地预测TBAD患者14 d内的死亡风险,有助于临床医生制定更合适的个体化治疗策略。

Objective To develop and verify a nomogram for predicting acute phase outcomes in patients with type B aortic dissection（TBAD）,enabling clinicians to more precisely evaluate mortality risk in TBAD patients during the acute stage and to devise better treatment plans．Methods This retrospective study analyzed demographic and clinical data of 399 TBAD patients from the Medical Information Mart for Intensive Care IV v2.2,focusing on mortality within 14 days of the acute phase in TBAD patients． Initially,the Least Absolute Shrinkage and Selection Operator regression was employed for feature variable selection,and then multivariate analysis was used to identify independent prognostic factors for constructing the predictive model．The nomogram predictive model's effectiveness and clinical applicability were assessed via the Receiver Operating Characteristic curve,calibration curve,and Decision Curve Analysis（DCA）．Results Acute Physidogy Score Ⅲ score,total carbon dioxide,and red blood cell distribution width emerged as independent predictors of 14-day mortality in TBAD patients．The internal validation of the nomogram predictive model showed an area under the curve of 0.776（95%CI：0.691-0.860）,with a Hosmer-Lemeshow test P-value of 0.604． The close alignment of the calibration and standard curves suggested the model's strong discriminative power and calibration． Furthermore,the DCA curve revealed that the predictive model offered substantial net benefits within a wide range of threshold probabilities．Conclusions This study's nomogram,developed using APS Ⅲ score,total carbon dioxide,and red blood cell distribution width,accurately predicts the 14-day mortality risk in TBAD patients,assisting clinicians in creating better personalized treatment plans．

目的 探讨术前血清肌酐（sCr）、估测肾小球滤过率（eGFR）对急性A型夹层术后急性肾损伤3级（AKI 3级）及连续性肾脏替代治疗（CRRT）的影响。方法 回顾性分析广州市第一人民医院2017年1月—2022年12月6年间收治的143例行Bentall或升主动脉置换+Sun’s手术的急性Stanford A型夹层患者术前sCr及eGFR、术后24 h及48 h sCr、尿量、术后AKI及CRRT情况。应用ROC曲线（受试者特征曲线）分析术前sCr、eGFR对术后AKI 3级及CRRT的影响。结果 术后AKI 3级27例（18.9%）,CRRT 14例（9.8%）。发生AKI 3级及CRRT的患者术前sCr水平升高（AKI3级与AKI0-2级组间比较t’=-2.722,P=0.011,CRRT与非CRRT组间比较t’=-2.184,P=0.048）、eGFR降低（AKI3级与AKI0-2级组间比较t=4.585,P<0.001,CRRT与非CRRT组间比较t=4.932,P<0.001）。ROC曲线分析提示术前sCr可有效预测术后AKI 3级（AUC 0.768,临界点123 μmol/L,灵敏度67%,特异度85%）及CRRT（AUC 0.848,临界点137.5 μmol/L,灵敏度71%,特异度88%）。eGFR可预测AKI 3级[AUC 0.761,临界点56.25 mL/（min·1.73 m²）,灵敏度67%,特异度83%]及CRRT[AUC 0.855,临界点47.6 mL/（min·1.73 m²）,灵敏度71%,特异度87%]。手术合并低心排血量等肾灌注不良时,eGFR低于75.9 mL/（min·1.73 m²）,术后CRRT发生率增加。结论 急性A型夹层术前sCr及eGFR影响术后AKI 3级及CRRT的发生。sCr>123 μmol/L、eGFR低于58.25 mL/（min·1.73 m²）的患者术后AKI 3级发生率增加。sCr>137.5 μmol/L、eGFR低于47.6 mL/（min·1.73 m²）,或合并肾灌注不良的患者术后CRRT发生率增加。

Objective To explore the influences of preoperative serum creatinine（sCr）and estimated glomerular filtration rate（eGFR）on postoperative stage 3 acute kidney injury（AKI）or continuous renal replacement treatment（CRRT）in patients with acute Stanford type A aortic dissection（ATAAD）．Methods From July 2017 to December 2022,143 ATAAD patients who underwent Bentall or ascending aortic replacement and total arch replacement and stented elephant trunk were retrospective analyzed．Data included preoperative sCr and eGFR,postoperative sCr,eGFR,urine volume,AKI and CRRT at 24 h and 48 h．Receiver operating characteristic（ROC）curve were used to analyze the influences of preoperative sCr and eGFR on stage 3 AKI and CRRT．Results Stage 3 AKI occurred in 27（18.9%）patients,including 14 patients who required CRRT．sCr was significantly higher in stage 3 AKI or CRRT group（AKI 3 vs AKI 0-2 group：t’=-2.722,P=0.011,CRRT vs non-CRRT group：t’=-2.184,P=0.048）,and eGFR was significantly lower（AKI 3 vs AKI 0-2 group：t=4.585,P<0.001,CRRT vs non-CRRT group：t=4.932,P<0.001）．Preoperative sCr could effectively predict postoperative stage 3 AKI（AUC 0.768,the best cut-off value was 123 μmol/L,sensitivity 67%,specificity 85%）and CRRT（AUC 0.848,the best cut-off value was 137.5 μmol/L,sensitivity 71%,specificity 88%）．Preoperative eGFR could predict postoperative stage 3 AKI（AUC 0.761,the best cut-off value was 56.25mL/（min·1.73 m²）,sensitivity 67%,specificity 83%）and CRRT（AUC 0.855,the best cut-off value was 47.6 mL/（min·1.73 m²）,sensitivity 71%,specificity 87%）．CRRT requirement significantly increased in patients with eGFR lower than 75.9 mL/（min·1.73 m²） who complicated with peripheral malperfusion．Conclusion sPreoperative sCr and eGFR have significant influences on incidence of postoperative stage 3 AKI and CRRT．Postoperative stage 3 AKI significantly increase in patients with sCr more than 123 μmol/L or eGFR lower than 56.25mL/（min·1.73 m²）．Postoperative CRRT significantly increase in patients with sCr more than 137.5 μmol/L,eGFR lower than 47.6mL/（min·1.73 m²）,or peripheral malperfusion．

目的 分析经胸超声心动图在Stanford A 型主动脉夹层的直接征象、间接征象和优缺点,探讨超声心动图在其诊断及预后评估中的应用价值。方法 回顾性收集2018年9月—2020年6月在我院诊治的A型主动脉夹层患者的临床资料,分析超声心动图的应用价值,以及住院期间发生不良预后的高风险因素。结果 经胸超声心动图直接征象诊断 A 型主动脉夹层的敏感性低于CTA,但对受累主动脉瓣结构及其功能评价优于CTA。 院内不良预后的发生率为42%, A型夹层的病因多与高血压相关,主动脉瓣返流、心包积液、手术时间长等是其高风险因素。结论 经胸超声心动图对A型主动脉夹层的早期诊断有较高的初筛价值,在局限于主动脉窦部夹层及观察主动脉瓣是否受累及有独特的优势,对于手术方式的选择和预后的判断有指导意义。

Objective To analyze the direct signs, indirect signs, advantages and disadvantages of transthoracic echocardiography in Stanford A-type aortic dissection, and explore the application value of echocardiography in its diagnosis and prognostic evaluation. Methods Retrospectively collect the clinical data of patients with type A aortic dissection diagnosed and treated in our hospital from Sept 2018 to Jun 2020, and analyze the application value of echocardiography and the high-risk factors for poor prognosis during hospitalization. Results The direct signs of transthoracic echocardiography were less sensitive than CTA in the diagnosis of type A aortic dissection, but it was better than CTA in evaluating the structure and function of the affected aortic valve. The incidence of poor prognosis in the hospital was 42%. The cause of type A dissection was mostly related to hypertension. Aortic regurgitation, pericardial effusion, and long operation time were high-risk factors. Conclusion Transthoracic echocardiography has a higher initial screening value for the early diagnosis of type A aortic dissection. It has unique advantages in confining to the aortic sinus dissection and observing whether the aortic valve is involved, the choice of surgical methods and the judgment of prognosis has guiding significance.

目的 探讨Stanford B型胸主动脉夹层腔内修复(TEVAR)术后不同类型内漏的产生机制及处理措施。方法 收集整理2008年9月—2017年2月间在我院诊断为Stanford B型胸主动脉夹层并接受TEVAR术治疗的105例患者的临床及影像资料,分析术中及术后出现内漏的原因,根据内漏来源及渗漏量给予不同处理,观察处理后内漏的变化情况。结果 术中出现急性内漏11例,包括Ⅰ型内漏8例(7.6%)和Ⅱ型内漏3例(2.8%);迟发内漏3例,包括Ⅰ型内漏1例(1.0%)和Ⅱ型内漏2例(1.9%),内漏总发生率为13.3%。术后患者未出现支架移位、截瘫、肾动脉缺血等严重并发症。结论 根据内漏产生的原因不同,内漏分为5型,其中Ⅰ型及Ⅱ型内漏较为常见,不同类型内漏处理方式不同,正确判断内漏类型是合理、有效处理内漏的前提。

Objective To investigate the causes of different types of endoleak after thoracic endovascular aortic repair(TEVAR)for Stanford type B aortic dissection, and to discuss its management. Methods The clinical data and imaging data of 105 patients with Stanford type B aortic dissection, who were admitted to authors' hospital during the period from September 2008 to February 2017 to receive TEVAR, were collected and reviewed. Reasons of intraoperative endoleak or after operation were analyzed, different treatments for the source of endoleak and leakage were taken and the conversions followed were observed. Results Acute endoleak was occurred in 11 patients during operation, including endoleak typeⅠ (n=8,7.6%)and endoleak type Ⅱ (n=3,2.8%). Delayed endoleak was seen in 3 patients, including endoleak typeⅠ (n=1,1.0%)and endoleak type Ⅱ (n=2,1.9%). Both in-operative and postoperative endoleak occurred in 14 patients (13.3%). After TEVAR, no serious complications such as displacement of stent, paraplegia or renal artery ischemia occurred. Conclusion According to the different reasons, endoleak can be divided into five types, among them, type Ⅰ and type Ⅱ are most common. Different endoleak should be handle in different ways.Correct judgment of endoleak type is the premise of reasonable and effective treatment for endoleak.

目的 急性Stanford A型主动脉夹层(AAAD)患者往往需急诊手术,以挽救其生命。手术通常存在高风险。术后常见并发症包括:神经系统、呼吸系统、胃肠道、肝、肾脏等多器官系统的功能障碍,以及全身感染,其使得术后过程更加复杂。 因此, 围术期护理极为重要。方法 2016年2月—2018年2月, 共完成了24 例 AAAD患者的手术。术前所有病人收治科室ICU。手术方式为Bentall+Sun'氏术。 围术期,对患者随机分组进行密切观察和护理。A组:常规组(routine nursing):对患者给予常规护理;B组:整体组(integrated nursing):除了常规的基本护理外,加强了围术期镇静、镇痛和术后并发症的专业化的整合护理。结果 两组共24例成功完成了手术。两组术前资料比较,无显著差异。整体护理组ICU停留时间和住院时间短于常规组(P<0.05);护理满意度、生活质量比较,整体组患者优于常规组(P<0.05)。结论 护士提供的围术期专业化技术的整体护理,可改善患者围术期的治疗效果,促进康复。

       目的   构建并验证主动脉夹层B型（TBAD）患者急性期预后的列线图预测模型，帮助临床医生在急性期内更准确地评估TBAD患者的死亡风险，并制定更合适的治疗策略。方法   回顾性分析从重症监护医学信息数据库v2.2 中提取的399例 TBAD患者的人口学资料和临床资料，结局为TBAD患者急性期（≤14 d）内死亡。先采用最小绝对收缩选择算法回归筛选特征变量，再采用多因素分析确定独立预后因素，并据此构建预测模型。通过受试者工作特征曲线、校准曲线、决策曲线分析（DCA）评价列线图预测模型的性能和临床适用性。结果  APS Ⅲ评分、二氧化碳总量、红细胞分布宽度为TBAD患者14 d内死亡的独立预测因素。列线图预测模型在内部验证中的受试者工作特征曲线下面积为0.776（95% CI：0.691 ~ 0.860），Hosmer-Lemeshow 检验P=0.604，校准曲线和标准曲线高度重合，表明该模型具有良好的区分度和校准度。同时，DCA曲线显示，预测模型在大部分的阈值概率范围内提供了显著的净收益。结论   本研究基于APS Ⅲ评分、二氧化碳总量、红细胞分布宽度构建的列线图预测模型可以较准确地预测TBAD患者14 d内的死亡风险，有助于临床医生制定更合适的个体化治疗策略。

       Objective  To develop and verify a nomogram for predicting acute phase outcomes in patients with type B aortic dissection（TBAD），enabling clinicians to more precisely evaluate mortality  risk in TBAD patients during the acute stage and to devise better treatment plans．Methods  This retrospective study analyzed demographic and clinical data of 399 TBAD patients from the Medical Information Mart for Intensive Care IV v2.2，focusing on mortality within 14 days of the acute phase in TBAD patients．Initially，the Least Absolute Shrinkage and Selection Operator regression was employed for feature variable selection，and then multivariate analysis was used to identify independent prognostic factors for constructing the predictive model．The nomogram predictive model’s effectiveness and clinical applicability were assessed via the Receiver Operating Characteristic curve，calibration curve，and Decision Curve Analysis（DCA）．Results  Acute Physidogy Score Ⅲ score，total carbon dioxide，and red blood cell distribution width emerged as independent predictors of 14-day mortality in TBAD patients．The internal validation of the nomogram predictive model showed an area under the curve of 0.776（95%CI：0.691-0.860），with a Hosmer-Lemeshow test P-value of 0.604．The close alignment of the calibration and standard curves suggested the model’s strong discriminative power and calibration．Furthermore，the DCA curve  revealed that the predictive model offered substantial net benefits within a wide  range of threshold probabilities．Conclusions  This study's nomogram，developed using APS Ⅲ score，total carbon dioxide，and  red blood cell distribution width，accurately predicts the 14-day mortality risk in TBAD patients，assisting clinicians in creating better personalized treatment plans．