8例老年人夹层动脉瘤临床与病理分析  

A clinicopathological study of aortic dissection in the aged:Report of 8 cases

作　　者：毛利民[1] 周月秀[1] 陈曼丽[1] 钱贻简[1] 

机构地区：[1]卫生部北京医院

出　　处：《实用老年医学》1997年第3期124-125,共2页Practical Geriatrics

摘　　要：目的老年夹层动脉瘤患者多病情危重，本文分析其临床表现、病理特征和预后。方法报道经尸检证实的８例老年患者的临床和病理改变资料。结果７例患者伴有高血压，所有患者均有冠心病。７例患者因夹层动脉瘤发作而猝死，另１例诊断夹层动脉瘤１４个月后，猝死于脑出血。仅１例患者诉心前区疼痛，另１例胸闷。大多数患者误诊为急性心肌梗塞、心脏破裂、急性心力衰竭或心原性休克。尸检发现４例为ＤｅＢａｋｅｙⅡ型，均逆行剥离致心包填塞。３例为ＤｅＢａｋｅｙⅢａ型。另１例左颈总动脉内夹层血肿，可能引起反射性心跳骤停。所有患者夹层血肿长度均不超过１５ｃｍ。Ⅲａ型中１例患者降主动脉３处夹层血肿，且动脉内膜无破损，为主动脉滋养血管破裂所致。结论老年人夹层动脉瘤发病急骤，临床症状不典型，易误诊和猝死。Objective As aortic dissection is a critical clinical condition and usually misdiagnosed,it is necessary to know its clinical manifestations and pathological features,especially in the aged so as to raise the diagnostic accuracy. Methods The data of the clinical manifestations and pathological changes of 8 aged patients with aortic dissection having autopsy performed in Beijing Hospital from 1965 to 1991 were studied and analyzed. Results 7 of the 8 patients had hypertension and all had coronary heart disease.7 patients died of aortic dissection suddenly and the remaining one of cerebral hemorrhage suddenly 14 months after the diagnosis of this disease in another hospital.Only two patients could possibly complained precordial pain and opression over the chest.Most of the cases were misdiagnosed as acute myocardial infarction ,rupture of heart,acute heart failure or cardiogenic shock.Pathologically,4 cases were found to be of DeBakey type Ⅱ with retrograde dissection leading to cardiac tamponade,3 were of DeBakey type Ⅲ a and the remaining one had dissection of left common carotid artery with possibly reflex cardiac standstill.None of the patients had dissection longer than 15 cm.Among the 3 cases of type Ⅲ a,one had 3 sites of dissection on the wall of thoracic descending aorta with no tear in the intima ,caused probably by rupture of the vasa vasorum. Conclusions Aortic dissection in the aged has usually abrupt onset and atypical clinical manifestations,is liably to be misdiagnosed and causes sudden death in most of the cases.None of the cases in this series had dissection in the abdominal aorta.

关 键 词：夹层动脉瘤 病理学 猝死 老年 

分 类 号：R543.160.2[医药卫生—心血管疾病]