下壁导联ST段抬高急性主动脉夹层临床分析  

Clinical analysis of suspected acute aortic dissection with ST-segment elevation detected by inferior leads

作　　者：余剑波[1] 杜昌[1] 黄文凤[1] 马云晖[1] 董桂英[1] 吕佳璇[1] 裴源源 来继红[1] 

机构地区：[1]北京大学人民医院急诊科,北京100044

出　　处：《中华急诊医学杂志》2016年第7期883-886,共4页Chinese Journal of Emergency Medicine

摘　　要：目的分析下壁导联ST段抬高的急性主动脉夹层临床特征，减少误诊，及时采取正确治疗策略。方法回顾性分析14例下壁导联ST段抬高的急性主动脉夹层临床表现、心电图特点、影像学表现、实验室检查、冠脉造影表现和治疗转归等资料。结果下壁导联ST段抬高的急性主动脉夹层患者相关临床表现提示单一高血压危险因素占79％，就诊时血压正常或高血压比例为86％；心电图提示sT段抬高幅度STⅢ〉STⅡ并伴V1或V4R导联ST段抬高比例为86％；实验室检查提示平均D-二聚体〉2000ng／mL；冠脉造影表现为未显示冠脉开口、冠脉血管正常或单纯右冠近端病变等；经胸心脏超声和胸部CT大血管造影对本病的识别率达到100％；本组患者的病死率为50％。结论下壁导联sT段抬高的急性主动脉夹层患者病情危重，病死率高，急诊手术治疗能明显提高患者生存率。Objective To analyze the clinical characteristics of suspected acute aortic dissection with ST-segment elevation detected by inferior leads in order to avoid the misdiagnosis of acute aortic dissection facilitating an appropriate treatment strategy carried out in time. Methods A total of 14 patients with suspected acute aortic dissection with ST-segment elevation detected by inferior leads were enrolled. Their clinical presentation, ECG features, imaging findings, laboratory testing, coronary angiography results, treatment and outcome were retrospectively analyzed. Results Clinical characteristics of suspected acute aortic dissection with ST-segment elevation detected by inferior leads suggested that hypertension as a single risk factor accounted for 79%. The patients with normal blood pressure or high blood pressure in emergency visits accounted for 86%. The amplitude of ST elevation in lead Ⅲ was greater than that in lead Ⅱ , and lead m accompanied with ST elevation in lead V1 or V4R accounted for 86%. Significantly elevated D- dimer 〉2 000 ng/mL was found in those patients. Coronary angiography showed that the opening of coronary artery not seen, normal coronary arteries or a simple right coronary artery proximal lesion. Transesophageal echocardiography and computed tomography angiography were used to identify the diagnosis with 100% accuracy. The mortality rate of this group was 50%. Conclusions Patients with acute aortic dissection evidenced by ST-segment elevation detected by inferior leads are in critical setting of high mortality. Emergency surgical treatment can significantly improve the survival rate of patients.

关 键 词：下壁导联ST段抬高 急性主动脉夹层 临床特征 

分 类 号：R543.1[医药卫生—心血管疾病]