肺动脉夹层的诊断与治疗  

The Diagnosis and Treatment of Pulmonary Artery Dissection

作　　者：孙宏涛[1] 于存涛[1] 常谦[1] 魏以桢[1] 冯钧[1] 徐晋[1] 

机构地区：[1]中国医学科学院北京协和医学院阜外心血管病医院心血管病研究所心脏外科,北京100037

出　　处：《中国胸心血管外科临床杂志》2011年第1期45-48,共4页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

摘　　要：目的总结治疗肺动脉夹层患者的临床经验,以期提高对该疾病的诊治水平。方法回顾性分析北京阜外心血管病医院1996年10月至2009年5月收治4例肺动脉夹层患者的临床资料,其中男3例,女1例;平均年龄31岁（17-45岁）。1例为肺动脉夹层合并主动脉根部瘤、主动脉夹层（Ⅱ型）,在深低温停循环下行Bentall手术＋全弓置换术＋肺动脉成形术;1例为动脉导管未闭、重度肺动脉高压,动脉导管介入封堵失败后出现肺动脉夹层,行保守治疗;1例为肺动脉夹层合并室间隔缺损、重度肺动脉高压,在体外循环下行单纯室间隔缺损修补术,肺动脉夹层未予处理;1例为肺动脉夹层合并室间隔缺损、动脉导管未闭和艾森门格综合征,行保守治疗。结果本组4例患者中死亡1例,该患者从发病到肺动脉夹层破裂自然病程仅60 h,死于急性心脏压塞;其余3例痊愈出院。随访2例,失访1例,随访时间分别为3个月和4年,均生存,心功能分级（NYHA）Ⅰ-Ⅱ级。结论肺动脉夹层罕见,易破裂,预后差;临床症状不典型,容易漏诊;对于慢性肺动脉高压患者,突然出现剧烈胸痛、劳累性呼吸困难、紫绀或血流动力学恶化、心源性休克,应该考虑到肺动脉夹层的可能;彩色超声心动图、CT、磁共振成像（MRI）均能简单快捷地确诊;治疗上应根据肺动脉夹层形成的具体原因,选择积极手术或保守治疗方案,以避免夹层破裂,挽救患者生命。Objective To summarize the clinical experiences of treatment of pulmonary artery dissection,in order to improve the diagnosis and treatment of the disease. Methods We retrospectively analyzed the clinical data of 4 patients including 3 males and 1 female with pulmonary artery dissection who were treated in Fu Wai Hospital between October 1996 and May 2009.Their age ranged from 17 to 45 years with an average age of 31 years.One patient with pulmonary artery dissection with aortic root aneurysm and chronic type Ⅱ aortic dissection was treated with Bentall＇s surgery,total arch replacement and pulmonary artery angioplasty under deep hypothermic circulatory arrest.One patient with pulmonary artery dissection with patent ductus arteriosus（PDA） and severe pulmonary hypertension after a failed PDA transcatheter closure was treated with conservative strategy.For the one patient with pulmonary artery dissection with ventricular septal defect（VSD） and severe pulmonary arterial hypertension,VSD was repaired under cardiopulmonary bypass while left pulmonary artery dissection was left untreated.And conservative treatment was carried out for another patient with pulmonary artery dissection with VSD,PDA and Eisenmenger＇s syndrome. Results Three patients recovered and 1 patient died of acute pericardial tamponade due to rupture of the dissection within 60 hours after onset of dissection.Follow-up was done in 3 cases with 1 lost.The follow-up time was 3 months and 4 years respectively.The New York Heart Association was class Ⅰ and Ⅱ. Conclusion Dissection of the pulmonary artery is a rare disease with a tendency of rupture and bad prognosis.Symptoms of pulmonary artery dissection are nonspecific,which can cause missed diagnosis.In patients with chronic pulmonary hypertension,the sudden seizure of chest pain,exertional dyspnea,and cyanosis,or worsened hemodynamics and cardiac shock may indicate pulmonary artery dissection which can be easily detected with echocardiography,CT scan and magnetic resonance imaging.Cor

关 键 词：肺动脉夹层 诊断与治疗 心脏外科 

分 类 号：R654.3[医药卫生—外科学]