急性A型主动脉夹层45例临床分析  

Clinical analysis of acute type A aortic dissection

作　　者：彭长农[1] 衣为民[1] 徐验[1] 龙娟[1] 张治伟[1] 李忠红[1] 王涓[1] 

机构地区：[1]深圳市孙逸仙心血管医院内科,广东深圳518002

出　　处：《罕少疾病杂志》2004年第4期31-33,共3页Journal of Rare and Uncommon Diseases

摘　　要：目的 了解急性升主动脉夹层的临床特征以及急诊外科手术和内科药物治疗对此类患者预后的影响。 方法 对45例急性升主动脉夹层患者的临床资料进行分析,将纳入研究的病例分为药物治疗组和急诊外科手术治疗组,分析两组患者住院并发症的发生率以及死亡率等指标。 结果 39例患者首发症状为颈、胸、背部"撕裂"样难以忍受的剧烈疼痛,31例既往有高血压病史,7例为马凡综合征患者。23例急性A型夹层患者行药物治疗,另外22例患者经确诊后行急诊外科手术治疗。45例患者中13例于住院期间死亡(28.9％),其中药物治疗组有9例(39.1％),手术治疗组有4例(18.2％),两组差异显著(39.1％vs 18.2％,P<0.001)。结论 急性升主动脉夹层,有很高的住院死亡率和严重并发症的发生率。急诊外科手术可明显降低患者的死亡率,改善患者的预后。Objective To study the clinical characteristics and the treatment effects of patients with acute type A aortic dissection. Methods 45 cases of acute type A aortic dissection were analyzed retrospectively. 2 kinds of treatment modality including drug therapy and surgical resection were performed in 23,22 cases respectively,of which the in-patient complications and mortality were analyzed. Results Of 45 patients with acute type A aortic dissection, 39 presented tearing pain of neck, chest and back strongly, 31 had hypertension, and 7 had Marfan syndrom which was exclusively associated with dissection in the young. The mortality rate of conservative drug therapy group and surgical resection group was 39.1%, 18.2% (P<0.001), respectivly. The overall mortality rate was 28.9% , which was caused mainly by aortic dissection rupture and organ malperfusion. Conclusion The in patient mortality rate of type A aortic dissection is still high. Surgical resection is superior to drug therapy in the treatment of acute type A aortic dissection.

关 键 词：升主动脉夹层 药物治疗 人工血管置换术 

分 类 号：R543.160[医药卫生—心血管疾病] R453[医药卫生—内科学]