主动脉壁内血肿的临床分析及中期随访结果  

Clinical Analysis and Mid-Term Follow-up of Aortic Intramural Hematoma

作　　者：魏以桢[1] 吕滨[2] 支爱华[2] 高鑫[3] 蒙延海[1] 常谦[1] 

机构地区：[1]中国医学科学院北京协和医学院心血管病研究所阜外心帆僻病医院血管外科中心,北京市100037 [2]中国医学科学院北京协和医学院心血管病研究所阜外心帆僻病医院影像诊断中心,北京市100037 [3]中国医学科学院北京协和医学院心血管病研究所阜外心帆僻病医院急重症抢救中心,北京市100037

出　　处：《中国循环杂志》2010年第3期205-207,共3页Chinese Circulation Journal

基　　金：中央级公益性科研院所基本科研基金资助,项目编号2007F005

摘　　要：目的:分析急诊来院确诊的主动脉壁内血肿患者临床特点,诊断及治疗和中期随访结果。方法:回顾分析从2007-08到2009-06连续58例经64排螺旋增强电子计算机断层摄影术(CT)确诊主动脉壁内血肿的临床资料,并进行随访。结果:58例主动脉壁内血肿患者,男41例,女17例,平均年龄(59.62±10.48)岁,47例(81.0%)有高血压病史,56例(96.6%)有急性胸背部疼痛,64排螺旋增强CT均可见异常征象,其中StanfordA型主动脉壁内血肿6例,StanfordB型主动脉壁内血肿52例。均给予降压和负性肌力药物治疗。54例内科药物治疗,4例行主动脉腔内覆膜支架术。随访48例,平均随访时间(10.16±6.14)个月。所有随访患者均存活,在2周至3个月期间30例(62.5%)患者血肿部分或完全吸收。1例患者CT复查形成StanfordB型主动脉壁内血肿,仍保守治疗,2例患者仍有心慌、气短,偶有胸背痛的症状,其余患者恢复满意。4例行主动脉腔内覆膜支架术的患者均恢复满意。结论:64排螺旋增强CT有助于提高主动脉壁内血肿的早期诊断及选择合适的治疗方法和改善预后。对大多数B型主动脉壁内血肿药物治疗效果满意。介入覆膜支架对有破裂风险的高危患者有帮助。Objective： To analyze the clinical characteristics,diagnosis and treatment of patients with aortic intramural hematoma （AIH） and their mid-term follow-up results. Methods ： A total of 58 consecutive patients with AIH from August 2007 to June 2009 admitted by emergency visit in our hospital were retrospectively summarized. There were 41 male and 17 female with the mean age of 59. 62± 10. 48 years. The diagnosis was confirmed by 64 detector enhanced spiral CT in each patient, and the follow-up study was carried out for 10. 16 ± 6. 14 months. Results： There were 47 （81.03 % ）patients with the history of hypertension,56（96. 6% ）suffered from the acute chest pain and back pain. 6 patients were diagnosed for Stanford type A AIH and 52 for Stanford type B AIH. All patients were treated with anti-hypertension and negative innotropics medication, and 4 received endovascular stented graft repair. 48 patients finished the follow-up study and 62. 5% of them showed partial or total absorption of the henmtoma between 2 weeks to 3 months after the on- set. 1 patient developed type B aortic dissection and received conservative medication, 2 suffered from palpitation and short of breath. All the rest patients had satisfied recovery, and 4 with the endovascular stented graft repair were in good condition as well. Conclusion： 64 detector enhanced spiral CT examination would improve the early diagnosis of aortic intramural hematoma and therefore improve the treatment and prognosis. Most of Stanford type B aortic dissection could be stabilized with the advanced medication. Endovascular stented graft repair could help the patient with the high risk of rupture potentials and reduce the short and mid-term mortality.

关 键 词：壁内血肿 诊断 治疗 主动脉腔内修复术 随访 预后 

分 类 号：R541[医药卫生—心血管疾病]