自发性冠状动脉夹层  

Spontaneous Coronary Artery Dissection

作　　者：马琼 徐日新 MA Qiong;XU Rixin(Dalian Medical University Graduate School,Dalian 116000,Liaoning,China;Department of Cardiology,Northern Jiangsu People s Hospital,Yangzhou 225002,Jiangsu,China)

机构地区：[1]大连医科大学研究生院,辽宁大连116000 [2]苏北人民医院心内科,江苏扬州225002

出　　处：《心血管病学进展》2018年第6期1051-1055,共5页Advances in Cardiovascular Diseases

摘　　要：自发性冠状动脉夹层是非医源性或外伤引起的冠状动脉管壁的自发分离。好发于中年女性,临床常表现为急性冠脉综合征。诊断主要依赖于冠状动脉造影,血管内超声或光学相干断层扫描具有重要的应用价值。自发性冠状动脉夹层的治疗可根据患者的临床特征选择个体化的方案,包括药物保守治疗和血运重建,其中,因为预后良好且夹层有自发愈合倾向,故目前认为保守治疗为第一选择。在中年女性急性冠脉综合征患者中,自发性冠状动脉夹层并非罕见,极易误诊为冠心病,应引起临床医生足够重视,一旦发现疑似病例,应启动相应的诊疗程序,避免误诊、误治。Spontaneous coronary artery dissection is defined as a spontaneous separation of the coronary artery wall that is not iatrogenic or related to trauma.It usually occurs in middle-aged women and often presents with acute coronary syndrome.The diagnosis of spontaneous coronary artery dissection has traditionally hinged upon coronary angiography.An individual treatment can be selected according to the clinical characteristics of the spontaneous coronary artery dissection patients.This includes conservative medical management and revascularization.After the initial acute ischemic attack,most patients stabilize and have a benign clinical course and eventually experience spontaneous healing of the vessel wall during follow-up.Accordingly,a conservative medical management has been recommended as the initial approach.It is not uncommon in middle-aged women with acute coronary syndrome and easy to be misdiagnosed as coronary atherosclerotic heart disease.Clinicians need a heightened focus and awareness that these events may not be isolated.Once suspected cases are found,the procedure of diagnosis and treatment should be initiated to avoid misdiagnosis.

关 键 词：自发性冠状动脉夹层 纤维肌发育不良 血管内超声 光学相干断层扫描 冠状动脉造影 

分 类 号：R543.3[医药卫生—心血管疾病]