主动脉夹层72例分析  

Aortic Dissection: An Analysis of 72 Cases

作　　者：梅志亮[1] 陈早芳[1] 周淑兰[1] 

机构地区：[1]江西省人民医院心血管内科,南昌330006

出　　处：《实用临床医学（江西）》2014年第10期10-12,共3页Practical Clinical Medicine

摘　　要：目的探讨主动脉夹层的临床特点及诊治方法。方法对72例主动脉夹层患者临床特点、诊断方法、治疗及并发症的发生情况进行回顾性分析。结果 72例患者中63例(87.5%)以剧烈胸背痛或腰腹痛为首发症状,发病时伴有高血压(70.8%,51/72)、脉搏短缺(8.3%,6/72)、血管杂音(9.7%,7/72)、主动脉瓣区杂音(11.1%,8/72)为主动脉夹层患者最常见临床特点;主动脉全层CTA为主动脉夹层患者首选且有确诊意义的检查。主动脉夹层分型以De BakeyⅢ型为最常见(90.3%,65/72),镇痛、β受体阻滞剂+降压治疗、主动脉腔内修复术为其主要治疗。48例行主动脉夹层腔内修复术,9例转外科行手术治疗,15例未行手术(假腔血栓形成未见明显破口3例,肠系膜上动脉、双肾动脉起自假腔不能手术1例,因破口位置复杂、外科风险高而未行手术2例,消化道出血并脑缺血、多脏器功能衰竭未手术3例,急性期主动脉破裂死亡2例,因病情严重自动出院4例)。好转出院61例,院内死亡7例,自动出院4例(未随访)。结论主动脉夹层患者多患有高血压病,症状以胸痛为主,主动脉CTA是首要检查方法,药物治疗是基础,腔内修复术是首选的治疗方法。Objective To investigate the clinical characteristics, diagnosis and treatment of aortic dissection（AD）.Methods The clinical characteristics, diagnostic methods, treatments and complications of 72 patients with AD were retrospective analyzed. Results The severe chest/back pain or waist/abdominal pain（87.5%, 63/72） was the initial symptom of AD patients. The hypertension（70.8%, 51/72）, pulse deficit（8.3%, 6/72）, vascular murmur（9.7%, 7/72） and aortic murmur（11.1%, 8/72） were the most common clinical characteristics of AD patients. The CTA was preferred and significative for the diagnosis of AD. De Bakey Ⅲ（90.3%,65/72） was the most common type of AD, and the analgesia, β-blockers plus antihypertensive therapy and endovascular graft exclusion were the main treatments for AD. Among the 72 patients, 48 underwent EVGE and 9 were converted to with surgical treatment. The operation was not performed in 15 patients, including false lumen thrombosis without obvious break in3, superior mesenteric artery and renal artery from the false lumen in 1, complex break location and high surgery risk in 2, digestive tract hemorrhage complicated by cerebral ischemia and multiple organ failure in 3, death due to acute aortic rupture in 2 patients, and hospital discharge due to severe illness in 4. Sixty-one patients achieved improvement and were discharged from hospital, and 7 patients died in the hospital. Conclusion The AD is often accompanied by hypertension and chest pain is the most common symptom of AD. The CTA is the preferred method for the diagnosis of AD. Drug therapy is the basis and EVGE is the preferred method for the treatment of AD.

关 键 词：主动脉夹层 高血压 影像学 腔内隔绝术 外科手术 

分 类 号：R543.1[医药卫生—心血管疾病]