主动脉夹层66例临床分析(1)
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【摘要】目的 通过探对主动脉夹层(AD)的症状和体征的回顾性分析，探讨本病的发病危险因素、临床表现及辅助检查对诊断的意义，提高对本病的认识和改善预后。方法 对2003年5月至2011年5月连续确诊的66例AD患者的临床资料进行回顾性分析。以x分析，以胸痛、心肌梗死为首发表现的多位于升主动脉，以背肩、腰腹累及下肢者多位于降主动脉。高血压是导至AD的常见病因。彩色多普勒超声、螺旋CT等影像学检查有助于快速诊断和定位。结论 AD的症状与夹层破口有一定关系。AD的形成与高血压有明显的相关性。早期诊断、及时治疗可改善预后。
【关键词】主动脉夹层 高血压 诊断
中图分类号：R543 文献标识码：A 文章编号：1005-0515(2012)3-039-02
Zhe clinical analysis of 66 case aortic dissection
ZHOU Jin SUN Yongming LI Shuangquan LAN Jinyu LEI Anping
(Hunan Provincial People's Hospital of Anxiang, Changde, Hunan 415600)
【Abstract】Objective explore the risk factors clinical appearance and examination methods of aortic dissection(AD)by a retrospective analysis. Method The clinical date of 76 AD patients admitted from May，2003 to May，2011 were retrospectively reviewed. Results The symptoms and physical signs of the 66 AD patients were diverse .Chest pain and AMI was a common initial symptoms but some patients were atypical. The origins of AD was ascending aorta when patients had clinical appearance mimicking myocardial infarction, and descending aorta when patients had pain involving shoulders, dorsum, waist, abdomen or lower limbs. Hypertension was the most important cause of AD. The combination use of echocardiography, CT and MRI may help to make rapid diagnosis. Conclusions The symptoms and physical signs of AD were diverse. Clinical symptom had some relationship with the origin of AD, the form of AD and hypertension had obvious relations. An obvious correlation exited between the occurrence of AD and hypertension. Early diagnosis, prompt treatment can improve prognosis.
【Key words】Aortic dissection Hypertension Diagnosis
主动脉夹层(AD)是血液渗入主动脉中层形成夹层血肿，并沿着主动脉壁延伸剥离所形成的一种严重的心血管急症，病死率高。由于本病受累部位与范围不同，临床表现复杂多变。现就我院2003年5月~2011年5月确诊为本病的66例患者进行临床分析，旨在提高对本病的认识，以便早期诊断与治疗。
1 资料与方法
1.1 一般资料 2003年5月~2011年5月在我院住院连续确诊的AD患者66例，男50例，女16例，男女比例近3：1，年龄35~81(51.7±11.6)岁。
1.2 症状 本组66例患者首发症状为剧烈胸痛者16例；剧烈胸、背痛者21例；背部疼痛者4例,剧烈背痛伴腰、腹部疼痛者5例，其中2例出现血尿，1例出现少尿；单纯腹痛者6例,其中有2例出现腹泻症状；腹痛伴博动性包块2例；出现血压下降、四肢厥冷等休克表现者3例；合并心肌梗死4例；肾功能不全4例；部分患者以神经系统症状为首发表现，其中2例发生晕厥，神志模糊2例，3例出现单侧、双下肢活动障碍，声音嘶哑1例。
1.3 AD的诊断依据根据病史及体征，经彩色Doppler超声诊断或疑似AD，进一步螺旋CT或MRI检查 ......
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