主动脉夹层23例临床诊治分析  

The clinical analysis on the diagnosis and treatment of aortic dissection in twenty-three patients.

作　　者：李北和[1] 朱志林[1] 俞彬[2] 袁超[1] 

机构地区：[1]三峡大学人民医院湖北省宜昌市第一人民医院心内科,443000 [2]三峡大学人民医院湖北省宜昌市第一人民医院病案室,443000

出　　处：《中国综合临床》2010年第2期152-154,共3页Clinical Medicine of China

摘　　要：目的探讨主动脉夹层的临床特点、诊断与治疗。方法回顾分析我院2006年1月至2008年4月收治的23例主动脉夹层患者的临床表现、影像学资料、治疗及转归情况。结果23例主动脉夹层中Ⅰ型8例、Ⅱ型5例、Ⅲ型10例，均合并有原发性高血压。临床表现典型者20例，占86．9％（20／23）；不典型者3例，占13．0％（3／23）。6例Ⅰ型夹层和5例Ⅱ型夹层行外科手术治疗，恢复顺利；1例Ⅰ型夹层和10例Ⅲ型夹层行覆膜支架腔内隔绝术治疗，Ⅰ型夹层患者于术后第7天凌晨起床小便时突然死亡，10例Ⅲ型夹层患者恢复顺利，未见不良反应；另1例Ⅰ型夹层患者因并发上消化道大出血而死亡。结论主动脉夹层临床表现典型者占绝大多数；不典型者占少数，极易发生漏诊和误诊，在中老年高血压患者中应保持警惕和注意识别，主动脉螺旋CT或磁共振（MRI）增强扫描检查是确诊的较好方法之一。Ⅰ型夹层和Ⅱ型夹层的治疗应以外科手术为主，而覆膜支架腔内隔绝术则是Ⅲ型夹层安全而有效的治疗方法。Objective To investigate the clinical features, diagnosis and treatment of aortic dissection. Methods Clinical data including manifestations,imageology, treatment and turnover in 23 patients with aortic dissection, hospitalized in our hospital from January 2006 to April 2008, were retrospectively analyzed. Results There were 8,5 and 10 cases classified in type Ⅰ ,type Ⅱ and typem ,all of them were complicated with hypertension. Typical syndromes were manifested in 20 patients （86.9%） and were not in the others （13.0%）. Surgical operation were performed in 6 patients of typeⅠ and 5 patients of type Ⅱ , and endovascular repairments were performed in 1 patient of type Ⅰand 10 patients of type Ⅲ. All the patients were recovered except that two patients of type Ⅰ died. Conclusions Most patients with aortic dissection present typical manifestision. CT or MRI is one of the most valuable diagnosis. The patients in type Ⅰ and type Ⅱ should be treated with the surgical operation, and the patients in type Ⅲ with endovascular stent-graft repairment.

关 键 词：主动脉夹层 影像学检查 

分 类 号：R543.1[医药卫生—心血管疾病] R656.6[医药卫生—内科学]