无症状主动脉夹层在健康体检中的发现和启示  

Detection and enlightenment of asymptomatic aortic dissection in physical examination

作　　者：伍朝春[1] 庞羽 李卫[1] 罗珍玉[1] 杨苏萍[1] 黄国秀[1] Wu Chaochun;Pang Yu;Luo Zhenyu;Huang Guoxiu(Health Management Center,People's Hospital of Guangxi Zhuang Autonomous Region,Nanning 530021,China)

机构地区：[1]广西壮族自治区人民医院健康管理中心,南宁530021

出　　处：《国际医药卫生导报》2020年第24期3743-3746,共4页International Medicine and Health Guidance News

基　　金：广西自然科学基金(2014GXNSFAA118274);广西多学科协作健康管理人才小高地项目(桂组通字〔2019〕85号-九);广西中医药管理局项目(Gzzc2019126)。

摘　　要：主动脉夹层是心血管系统的急危重症,一旦漏诊或延迟诊断易导致严重后果。本文回顾健康体检中发现的1例无症状主动脉夹层病例的处理过程及转归,结合文献进行分析。主动脉夹层的高危因素为高血压、动脉粥样硬化、遗传性结缔组织病、男性等。对于疑似主动脉夹层的早期识别,可能的线索包括:胸片提示主动脉弓或上纵隔影异常增宽扩张、D-二聚体明显增高、血压异常增高且双上肢血压不对称等。D-二聚体作为主动脉夹层以及其他血管危重症的预测指标,可适当引入到高风险人群的体检套餐中。同时,应加强急危重症知识培训,提高体检医师对主动脉夹层的早期识别能力;制定标准,对体检危急值报告、处理流程实行规范化管理,提高体检质量、降低医疗风险;加强高血压健康管理,降低主动脉夹层的发病风险。Aortic dissection(AD)is a critically serious disease of cardiovascular system,which may result in serious consequences if its diagnosis is missed or delayed.This paper reviews the treatment and outcome of a case of asymptomatic aortic dissection found in physical examination,and analyzes the literature.The high risk factors of aortic dissection are hypertension,atherosclerosis,hereditary connective tissue disease,dyslipidemia,male,etc.For the early identification of suspected AD,possible clues include abnormal widening and dilation of aortic arch or mediastinal shadow indicated by chest radiograph,obvious increase of D-dimer,abnormal increase of blood pressure and asymmetry of blood pressures of both upper limbs,etc.As a predictor of acute AD and other critical vascular diseases,D-dimer can be properly introduced into the physical examination package of high-risk population.At the same time,it is necessary to strengthen the training of critical knowledge to improve physicians'ability of early identification of AD,to formulate standards and standardize the reporting and handling process of critical values to improve physical examination quality and reduce medical risks,and to strengthen the health management of hypertension to reduce the risk of AD.

关 键 词：健康体检 主动脉夹层(AD) D-二聚体 危急值预警 高血压 健康管理 

分 类 号：R543.1[医药卫生—心血管疾病]