无痛无危险因素的主动脉夹层破裂出血误诊报告  

Misdiagnosis of Aortic Dissection Rupture Hemorrhage without Pain and Risk Factors

作　　者：刘元税[1] 宋维[1] 欧阳艳红[1] 张蕾蕾[1] 

机构地区：[1]海南省人民医院急诊科,海口570311

出　　处：《临床误诊误治》2016年第8期10-12,共3页Clinical Misdiagnosis & Mistherapy

摘　　要：目的探讨不典型主动脉夹层(aorticdissection,AD)的发生原因、临床特点及误诊原因,提高对其认识。方法回顾性分析1例无痛无危险因素急性AD的临床资料。结果本例因胸闷不适6 h,加重2 h来诊。曾在当地医院就诊,心电图及胸部X线正位片未见异常,诊断不明确。至我院急诊就诊后,经查体及急查胸部、上腹部CT考虑不排除胸主动脉瘤相关疾病,收住血管外科,行胸部、上腹部、下腹部增强CT检查确诊为AD。随后行急诊介入手术治疗,但患者术后出现循环衰竭,最终死亡。结论不典型AD临床易误诊。临床遇及出现胸腹部剧烈不适患者时接诊医师应高度重视,要结合患者病情亲自仔细查阅医技检查结果,休克指数对及时发现AD病情变化有重要意义。Objective Explore the occurrence causes,clinical features and misdiagnosis causes of atypical aortic dissection（ AD） and enhance the understanding of the disease. Methods Clinical data of one case of acute AD without pain and risk factors was retrospectively analyzed. Results The patient visited for thoracic discomfort for 6 hours and exacerbation for 2hours. Earlier the patient had been treated in a local hospital,but nothing abnormal was detected on electrocardiogram and chest X-ray films（ PA position）,therefore the diagnosis was indefinite. Later the patient was admitted to the emergency department of our hospital. After checking up and urgent midsection CT examination,thoracic aortic aneurysm was suspected and the related disease was not excluded. Then the patient was hospitalized for vascular surgery. After enhanced CT checking on chest,midsection and hypogastrium,the patient was diagnosed as having AD and emergency interventional operation was performed,but after the operation,the patient died of circulatory failure. Conclusion Atypical AD tends to be misdiagnosed in clinical practice.For patients with severe discomfort of chest and abdomen in clinical practice,doctors must pay close attention to it and check the medico-technical inspection results carefully. Shock index is of important value in detecting the changes of AD.

关 键 词：动脉瘤 夹层 误诊 

分 类 号：R543.16[医药卫生—心血管疾病]