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Objective To investigate the clinical characteristics,coagulation function and associated prognostic factors of acute aortic dissection.Methods The clinical data of 119 patients with acute aortic dissection (AAD) admitted to Beijing University People's Hospital from November 2008 to January 2016 were analyzed.All the participants were confirmed by computed tomography angiography,and the onset time was less than 14 days.Data of blood routine test,coagulation function at the first admission were collected,and surgical intervention and prognosis were recorded.All the patients,according to the prognosis,or whether disseminated intravascular coagulation (DIC) occurred,were divided into two groups,and the differences between the two groups were compared.Logistic regression analysis was applied to analyze independent risk factors related to in-hospital death in AAD patients.Results In 119 patients with AAD,the average age was (52.9±14.2) years,with a male/female ratio of 5.3:1.Pain was the most common clinical manifestation in patients with AAD,accounting for more than 90.0％.The nature of pain was mostly expansible and/or transitive pain.Dominant DIC occurred in 13 cases (10.9％),and 7 patients died (53.8％).There were significant differences between the DIC group and non-DIC group in neutrophil/lymphocyte ratio (NLR),platelet count,fibrinogen,D-dimer,FDP,PT,APTT and mortality rate (P＜0.05).All the 16 patients in the death group were type AAAD,among which,7 patients (43.8％) developed with DIC.There were significant differences between the death group and survival group in NLR,platelet count,fibrinogen,D-dimer,FDP,PT,APTT,DIC proportion and surgical operation rate (P＜0.05).Logistic regression analysis showed that NLR and platelet count were independent risk factors of in-hospital death (P＜0.05).Conclusions D-dimer has a high diagnostic and prognosis value for AAD.The mortality increased with the activation and depletion of platelet.Once DIC occurs,the prognosis is extremely poor.NLR and platelet count are independent risk factors for in-hospital death in patients with AAD.
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Objective@#To investigate the clinical characteristics, coagulation function and associated prognostic factors of acute aortic dissection.@*Methods@#The clinical data of 119 patients with acute aortic dissection (AAD) admitted to Beijing University People's Hospital from November 2008 to January 2016 were analyzed. All the participants were confirmed by computed tomography angiography, and the onset time was less than 14 days. Data of blood routine test, coagulation function at the first admission were collected, and surgical intervention and prognosis were recorded. All the patients, according to the prognosis, or whether disseminated intravascular coagulation (DIC) occurred, were divided into two groups, and the differences between the two groups were compared. Logistic regression analysis was applied to analyze independent risk factors related to in-hospital death in AAD patients.@*Results@#In 119 patients with AAD, the average age was (52.9±14.2) years, with a male/female ratio of 5.3:1. Pain was the most common clinical manifestation in patients with AAD, accounting for more than 90.0%. The nature of pain was mostly expansible and/or transitive pain. Dominant DIC occurred in 13 cases (10.9%), and 7 patients died (53.8%). There were significant differences between the DIC group and non-DIC group in neutrophil/lymphocyte ratio (NLR), platelet count, fibrinogen, D-dimer, FDP, PT, APTT and mortality rate (P<0.05). All the 16 patients in the death group were type A AAD, among which, 7 patients (43.8%) developed with DIC. There were significant differences between the death group and survival group in NLR, platelet count, fibrinogen, D-dimer, FDP, PT, APTT, DIC proportion and surgical operation rate (P<0.05).Logistic regression analysis showed that NLR and platelet count were independent risk factors of in-hospital death (P<0.05).@*Conclusions@#D-dimer has a high diagnostic and prognosis value for AAD. The mortality increased with the activation and depletion of platelet. Once DIC occurs, the prognosis is extremely poor. NLR and platelet count are independent risk factors for in-hospital death in patients with AAD.
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Objective To investigate the clinical characteristics and prognosis of patients with acute aortic dissection (AAD) and hypertension,and explore other related prognostic factors in AAD.Methods The present study enrolled consecutive patients diagnosed with AAD who were admitted to Peking University People's Hospital between January 2000 to December 2015.Patients diagnosed with AAD by CT angiography,aortography or magnetic resonance imaging within 14 days of onset were included.Patients with infectious diseases,haematological diseases,malignancies,autoimmune diseases and patients without clearly clinical diagnosis or incomplete data were excluded.The patients were initially divided into two groups based on their history of hypertension,and their clinical characteristics were compared and analyzed.We further divided AAD patients into survival group and death group according to their in-patient outcomes,and factors related to their prognoses were analyzed.Logistic regression analysis was applied to analyze the independent risk factors related to hospital death in AAD patients with P＜0.05 as the significant value.Results The hypertensive group contained 237/346 cases included (68.45％),patients in this group were generally older than their non-hypertensive counterparts,accompanied by increased prevalence of comorbidities (coronary heart diseases or diabetes) and a statistical significant elevated admission blood pressures (systolic and diastolic,P＜0.05).No significant difference were found between the groups in terms of white blood cell and platelet count,D-dimer,neutrophil to lymphocyte ratio(NLR),fibrinogen,serum creatinine and serum lipid profiles (P＞0.05).Hypertensive patients were less likely to receive surgical treatment compared with those without hypertension(P＜0.05),with increased risk of in-hospital mortality (P＞0.05).Further logistic regression analysis revealed the presence of hypertension did not independently predict in-hospital mortality of AAD patients.Factors such as age,Stanford classification of the AAD,NLR and platelet counts were found to have independent predictive values for in-hospital mortality (P＜0.05).Conclusion AAD patients with hypertension are generally older,have more comorbidities such as coronary heart diseases and diabetes.The presence of hypertension itself is not directly associated with in-hospital mortality in AAD patients,while the Stanford classification,age,NLR and platelet counts are independent risk predictors.
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Objective To investigate the clinical characteristics and associated prognostic factors of the acute aortic syndrome. Methods The clinical data of 391 patients with acute aortic syndrome (AAS) admitted to Beijing University People's Hospital from January 2000 to December 2015 were analyzed. Results In 391 patients with AAS, the average age was (52.7 ±13.3) with a male/female ratio of 4.3:1, and 73.4％ patients had hypertension. The most common clinical manifestation of patients with AAS was pain accounting for more than 90.0％, and the nature of pain was expansible and/or transitive pain. The level of D-dimer was elevated in 91.1％ of patients with AAS (ELISA), and significantly higher in type A patients than type B patients. Ultrasound/echocardiography was used to diagnose AAS with a sensitivity of 88.4％, of which the sensitivity of type A patients was 99.1％; the mortality of type A patients was significantly higher than type B patients (34.3％ vs. 0.9％, P <0.01). The mortality was declined obviously (11.7％ vs. 28.0％, P <0.01) when patients were treated with stent. Compared with the in-hospital surviving group, the in-hospital mortality group had decreased platelet counts and FIB, higher level of D-dimer, FDP and NLR (neutrophil to lymphocyte ratio). Conclusions Transitive and(or) expansible pains were the characteristic clinical manifestations of acute aortic syndrome,which usually happened suddenly or tearing;D - dimer and ultrasound were valueble and simple methods in AAS patients; Compared with In-hospital surviving group,the In-hospital mortality group had decreased platelet counts and FIB,higher level of D-dimer, FDP and NLR.The mortality of type A was significantly higher than type B,operation can lower the mortality of AAS patients obviously.
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Objective: To investigate the causes of the recurrent nasal polyps in patients with rhinosinusitis after endoscopic surgery and the problems of operative technique, classification and the management of postoperative were discussed. Methods: The clinical data of 38 patients with rhinosinusitis who had recurrent nasal polyps after endoscopic surgery were retrospected. Results: The causes of recurrent nasal polyps were incomplete remove of the upper nasal cavity in 13, adhesion of the middle turbinat in 12, obstruction of the maxillary sinus in 4, incomplete section of the polyps in maxillary sinus in 3, the deviation of the upper nasal septum in 3 and unknown in 3. Conclusion: Good knowledge of the functional anatomy of the endoscopic surgery, good endoscopic surgery skills, proper polyps section for the high site, extensive postoperative care and patients follow\|up are the important factors to prevent or reduce the recurrence of the nasal polyps.