Abstract: Background　Aortic dissection（AD） progresses rapidly once it occurs，and it has a relatively high mortality.According to overseas epidemiological statistics，AD has an incidence of 5/100 000 0 to 30/100 000 0.But timely diagnosis and reasonable treatment can reduce the mortality.Objective　To perform an analysis of in-hospital mortality and associated risk factors of AD and the changes in related diagnostic and therapeutic strategies based on 18-year data from General Hospital of Ningxia Medical University.Methods　752 AD inpatients from General Hospital of Ningxia Medical University were enrolled from January 2000 to December 2017.Demographic（gender，age，smoking history，alcohol consumption history，length of stay） and clinical data（symptoms，vital signs，comorbidities，complications，imaging and laboratory data） were collected.Changes in admission departments during these years were analyzed.Treatment option（medication or medication with surgery） and outcome（death or survival） of them were compared between type A patients（n=237） and type B patients（n=515） stratified by Stanford classification of AD.Treatment option，in-hospital mortality，and nosocomial infection incidence were compared between those treated in 2000—2008（group 1，n=196） and those treated in 2009—2017（group 2，n=556）.In-hospital outcomes（104 deaths and 648 survivals） were analyzed.Factors associated with in-hospital mortality of AD were identified by multivariate Logistic regression.Results　Of the participants，65（8.64%） and 687（91.36%） hospitalized in internal medicine department，and surgery department，respectively.The number of patients and those hospitalized in surgery department increased with years，showing similar growth trends.But the annual number of those hospitalized in internal medicine department maintained less than 10.253（33.64%）.253（33.64%） and 499（66.36%） received medical treatment，and surgical treatment，respectively.Treatment options differed significantly across type A and type B patients（P<0.001）.Type A patients showed a higher in-hospital mortality（P<0.001）.The proportion of medical treatment，in-hospital mortality and in-hospital mortality of type A patients in group 1 were higher than those in group 2（P<0.05）.Multivariate Logistic regression analysis showed that type A dissection，increased heart rate，elevated white blood cell count，and nosocomial infection were associated with increased risk of in-hospital mortality of AD（P<0.05）.Conclusion　The in-hospital mortality of AD was reduced significantly during this period in the hospital.Surgical treatment may be an effective treatment for AD.Type A dissection，increased admission heart rate，elevated white blood cell count，and nosocomial infection were independent risk factors of in-hospital mortality of AD.

Key words: Aortic diseases, Aortic dissection, Risk factor, Death, Retrospective studies

摘要： 背景　主动脉夹层（AD）一旦发病，其病情进展迅速，死亡率较高。据国外流行病学统计，AD的发病率为5/百万~30/百万，及时诊断和合理治疗可以降低死亡率。目的　分析宁夏医科大学总医院18年来收治的AD患者院内死亡的危险因素和死亡率，以及AD诊治策略变迁与进展。方法　选择2000年1月—2017年12月在宁夏医科大学总医院住院治疗的AD患者752例。分析AD患者收住科室变化趋势；根据Stanford分型法将AD患者分为A型237例和B型515例，分析各型患者的治疗方式（单纯内科药物治疗为内科治疗，药物治疗的同时实施手术为手术治疗）及住院转归（院内死亡与否）；依据患者入院先后顺序分为1组（2000—2008年）196例和2组（2009—2017年）556例，观察两组治疗方式、院内死亡率、院内感染发生率的变化；根据患者院内转归分为死亡组（104例）和存活组（648例），收集患者的一般情况（性别、年龄、吸烟史、饮酒史、住院天数）和临床资料（临床症状、生命体征、合并症、并发症、影像学和实验室检查）。采用多因素Logistic回归分析探讨AD患者院内死亡的影响因素。结果　752例患者中，内科收住65例（8.64%），外科收住687例（91.36%）。患者总数与外科收住患者数均逐年增多，且二者增长趋势一致，内科收住患者数一直维持在年均不足10例。752例患者中内科治疗者253例（33.64%），手术治疗者499例（66.36%）；A型AD患者治疗方式与B型比较，差异有统计学意义（P<0.001）；A型AD患者死亡率高于B型（P<0.001）。1组内科治疗比例、院内死亡率、AAD型患者死亡率高于2组（P<0.05）。多因素Logistic回归分析结果显示，A型、心率增快、白细胞计数增高、院内感染是AD患者住院死亡的危险因素（P<0.05）。结论　18年间AD患者院内死亡率显著降低，手术治疗是AD的有效治疗选择。A型AD、入院时心率增快、白细胞计数增多、院内感染是AD院内死亡的独立危险因素。

关键词: 主动脉疾病, 主动脉夹层, 危险因素, 死亡, 回顾性研究