摘要
目的探讨行胸主动脉腔内修复术(TEVAR)的急性主动脉综合征(AAS)合并高血压患者出院后血压控制水平对预后的影响。方法本研究为回顾性研究。连续入选2002年6月至2021年12月于北部战区总医院确诊为AAS且行TEVAR、合并高血压的患者。分别于术后1个月、1年,及此后每2年随访,记录患者的平均收缩压及终点事件发生情况。依据患者的平均收缩压,分别以140、150 mmHg(1 mmHg=0.133 kPa)作为血压达标界值,将平均收缩压<140或150 mmHg者分为血压达标组,其余为血压未达标组。终点包括全因死亡、主动脉原性死亡、卒中、肾功能不全、主动脉相关不良事件和以上事件组成的复合终点(即总体临床不良事件),以及再次TEVAR。比较各随访时段两组的终点事件发生率。结果共纳入987例合并高血压的TEVAR术后患者,年龄(55.7±11.7)岁,其中男性779例(78.9%)。以平均收缩压<140 mmHg为血压达标标准时,术后1个月、1~12个月、1~3年血压达标率分别为71.2%(703/987)、66.7%(618/927)、65.1%(542/832);术后1个月[74.3%(211/284)比65.9%(463/703),P=0.010]、1~12个月[71.5%(221/309)比63.6%(393/618),P=0.016]血压未达标组应用降压药种类≥2的患者比例均高于血压达标组;上述随访时段内新发全因死亡、卒中、主动脉相关不良事件及再次TEVAR发生率在两组间差异均无统计学意义(P均>0.05)。以平均收缩压<150 mmHg为血压达标标准时,术后1个月、1~12个月、1~3年血压达标率分别为89.3%(881/987)、85.2%(790/927)、85.6%(712/832);术后1~12个月血压未达标组新发总体临床不良事件[8.8%(12/137)比4.2%(33/790),P=0.021]、再次TEVAR[4.4%(6/137)比1.0%(8/790),P=0.003]发生率较血压达标组高;1~3年血压未达标组的新发全因死亡率较血压达标组高[5.8%(7/120)比2.4%(17/712),P=0.037],新发总体临床不良事件发生率两组间差异无统计学意义(P>0.05)。结论行TEVAR的AAS合并高血压患者,平均收缩压≥150 mmHg时不良事件发生率增加。血压控制不良不利于患者预后,应积极控制血压。
Objective To investigate the influence of blood pressure control after discharge on prognosis of patients with acute aortic syndrome(AAS)complicated with hypertension who underwent thoracic endovascular aortic repair(TEVAR).Methods This is a retrospective case analysis.Patients diagnosed with AAS complicated with hypertension and undergoing TEVAR in Northern Theater Command General Hospital from June 2002 to December 2021 were consecutively enrolled.Average systolic blood pressure(SBP)and the occurrence of endpoint events were recorded at one month,one year and every 2 years after TEVAR.According to the patients′average SBP,patients with average SBP<140 mmHg(1 mmHg=0.133 kPa)or<150 mmHg were divided into the target blood pressure achievement group,and the others were divided into target blood pressure non-achievement group.Endpoint events included all-cause death,aortic death,stroke,renal insufficiency,aortic related adverse events and a composite of these events(overall clinical adverse events),and re-accepting TEVAR.The incidence of endpoint events was compared between the two groups at each follow-up period.Results A total of 987 patients were included,aged(55.7±11.7)years,including 779 male(78.9%).When the cutoff value was 140 mmHg,the rate of average target SBP achievement was 71.2%(703/987)at one month,66.7%(618/927)during 1st to 12th month and 65.1%(542/832)from the first year to the third year after TEVAR.The proportion of patients taking≥2 antihypertensive agents was higher in the group of target blood pressure non-achievement group than the target blood pressure achievement group after TEVAR at 1 month(74.3%(211/284)vs.65.9%(463/703),P=0.010)and during 1st to 12th month(71.5%(221/309)vs.63.6%(393/618),P=0.016).There were no statistical differences in the all-cause deaths,stroke,aortic related adverse events,and repeat TEVAR between the two groups(All P>0.05)during above follow-up periods.When the cutoff value was 150 mmHg,the rate of target SBP achievement was 89.3%(881/987)at one month,85.2%(790/927)during 1st to 12th month and 85.6%(712/832)from the first year to the third year after TEVAR.The incidence of clinical total adverse events(8.8%(12/137)vs.4.2%(33/790),P=0.021)and repeat TEVAR(4.4%(6/137)vs.1.0%(8/790),P=0.003)in target blood pressure non-achievement group were significantly higher than the target blood pressure achievement group during 1st to 12th month after TEVAR.The incidence of all-cause deaths(5.8%(7/120)vs.2.4%(17/712),P=0.037)in the target blood pressure non-achievement group was significantly higher than the target blood pressure achievement group from the first year to the third year follow-up period,but there were no statistical differences in the incidence of clinical total adverse events between the two group(P>0.05).Conclusion Among TEVAR treated AAS patients complicated with hypertension,the average SBP more than 150 mmHg post discharge is associated with increased risk of adverse events.Ideal blood pressure control should be encouraged to improve the outcome of these patients.
作者
李美岑
王亚松
周铁楠
张权宇
张磊
王效增
Li Meicen;Wang Yasong;Zhou Tienan;Zhang Quanyu;Zhang Lei;Wang Xiaozeng(Department of Cardiology,General Hospital of Northern Theater Command,Shenyang 110016,China)
出处
《中华心血管病杂志》
CAS
CSCD
北大核心
2023年第3期303-309,共7页
Chinese Journal of Cardiology
基金
辽宁省科技计划项目基金(2012225009)。
关键词
主动脉疾病
胸主动脉腔内修复术
血压
预后
Aortic diseases
Thoracic endovascular aortic repair
Blood pressure
Prognosis
