急性严重胸痛伴主动脉瓣区舒张期杂音患者的临床分析  

The clinical analysis of patients with acute serious chest pain and diastolic murmurs in the aortic vavle area

作　　者：童路[1] 帅欣欣[1] 李蔚华[2] 王国荣[1] 魏宇淼[1] 

机构地区：[1]华中科技大学附属协和医院心血管病研究所华中科技大学附属协和医院心内科,武汉430022 [2]华中科技大学附属梨园医院心内科

出　　处：《临床心血管病杂志》2017年第8期747-749,共3页Journal of Clinical Cardiology

基　　金：国家自然科学基金资助(No:81470483)

摘　　要：目的:探讨急性严重胸痛伴主动脉瓣区舒张期杂音的心血管急危重症患者的病因诊断、临床特点和预后判断。方法:收集急性严重胸痛伴主动脉瓣区舒张期杂音病例66例,分析其疾病诊断,观察其临床指标,记录有无首诊误诊以及严重临床事件、住院期间死亡终点事件。结果:66例患者以急性主动脉夹层Stanford A型(32例,占48.5%)、急性心肌梗死(AMI)伴主动脉瓣关闭不全(28例,占42.4%)多见,少数为急性主动脉窦瘤破裂(6例,占9.1%)。stanford A型急性主动脉夹层组白细胞计数、D-二聚体、C-反应蛋白明显升高的占比较高;AMI伴主动脉瓣关闭不全组多有糖尿病史,以心电图ST-T改变、肌钙蛋白I(TnI)升高及左室射血分数下降的比例较高;急性主动脉窦瘤破裂组以年轻患者突发严重心力衰竭及显著BNP升高的更常见。急性主动脉窦瘤破裂组首诊误诊率明显高于急性主动脉夹层Stanford A型及AMI伴主动脉瓣关闭不全组。急性主动脉窦瘤破裂组病死率明显低于急性主动脉夹层Stanford A型及AMI伴主动脉瓣关闭不全组。结论:临床上急性严重胸痛诊断时应高度关注主动脉瓣区舒张期杂音,警惕少见疾病,避免误诊,正确判断预后;尤其是D二聚体或CRP显著升高的患者,需注意非AMI的可能。Objective：To investigate the etiology diagnosis,clinical features and prognosis of cardiovascular critically illpatients with acute serious chest pain and diastolic murmurs in the aortic valve area.Method：Sixty-Six patients diagnosed in our hospital were included and divided into three groups：Stanford type Aacute aortic dissection（AAD）group,acute myocardial infraction（AMI）with aortic insufficiency group and acute ruptured aneurysm of sinus of Valsalva group.Clinical features and auxiliary examination results were reviewed.Misdiagnosis,serious clinical events and cardiac death events during hospitalization were also recorded.Result：There were 32cases（48.5%）in Stanford type A AAD group,28cases（42.4%）in AMI with aortic insufficiency group were more common,and only 6cases（9.1%）were in acute ruptured aneurysm of sinus of Valsalva group.Results showed that in stanford type A AAD Group,the poportion of obviously elevated levels of white blood cell count,C-reactive protein and D-Dimer increased significanty;In AMI with aortic insufficiency group,the patient with a history of diabetes and the percentage of ST-T dynamic change and elevated TnI and decline of left ventricular ejection was high.In acute ruptured aneurysm of sinus of Valsalva group,the proportion of young patients with suddenly actue serious heart failure and abnormally elevated levels of BNP was more common.The misdiagnosis rate of acute ruptured aneurysm of sinus of Valsalva group was significantly higher than that of Stanford type A AAD group and AMI with aortic insufficiency group.The mortality of acute ruptured aneurysm of sinus of Valsalva group was significantly lower than that of Stanford type A AAD and AMI complicated with aortic insufficiency group.Conclusion：In diagnosing acute chest pain,attention should be paid to diastolic murmurs in the aortic valve area,rare diseases should be noted to avoid misdiagnosis and judgement prognosis correctly.In particular,patients with a significant increase in D-Dimer and C-reactive

关 键 词：急性严重胸痛 主动脉瓣区舒张期杂音 病因诊断 临床特点 预后分析 

分 类 号：R544.1[医药卫生—心血管疾病]