无痛性主动脉夹层的临床诊治  

Clinical diagnosis and treatment of painless aortic dissection

作　　者：郑智[1] 查正彪[1] 张洁[1] 周福硕 陈涛[1] 魏翔[1] 潘友民[1] ZHENG Zhi;ZHA Zhengbiao;ZHANG Jie;ZHOU Fushou;CHEN Tao;WEI Xiang;PAN Youmin(Department of Cardiothoracic Surgery,Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430030,China)

机构地区：[1]华中科技大学同济医学院附属同济医院心脏大血管外科,430030

出　　处：《心肺血管病杂志》2022年第8期914-916,926,共4页Journal of Cardiovascular and Pulmonary Diseases

摘　　要：目的:探讨无痛性主动脉夹层的临床诊治情况。方法:收集81例无痛性主动脉夹层病例进行统计分析。结果:按时间跨度分成两组:2009年至2014年为A组29例,2015年至2020年为B组52例,下列指标两组间差异有统计学意义(P<0.05):以神经系统症状首诊的比例(27.6%vs.51.9%),从首诊到确诊的时间超过48h比例(72.4%vs.32.6%),保守治疗比例(62.1%vs.26.9%),在院病死率(41.4%vs.19.2%)。以临床症状分为神经系统症状及非神经系统症状两组,神经系统症状组A型夹层比例(71.4%vs.36.9%)及病死率(40.0%vs.17.4%)均高于和非神经系统症状组(P<0.05)。以治疗方案分保守治疗组和非保守治疗组,保守治疗组病死率(46.8%)高于非保守治疗组(14.3%,P<0.05)。结论:无痛性主动脉夹层发病凶险,随着诊断和手术治疗水平的提高,得到及时诊治,病死率明显下降。Objective: To demonstrate clinical diagnosis and treatment of painless aortic dissection.Methods: A total of 81 cases of painless aortic dissection were recruited in this study. Results: All cases were divided into two groups by time span. Twenty-nine cases were included in group A(from 2009 to 2014), and fifty-two were in group B(from 2015-2020). The difference in the following clinical data was significant between two groups: the proportion of patients with first presentation of neurological symptoms(27.6% vs.51.9%), the proportion of patients who were diagnosed as painless aortic dissection beyond 48 hours after the occurence of the first symptom(72.4% vs.32.6%), the proportion of patients with conservative treatment(62.1% vs.26.9%), mortality in hospital(41.4% vs.19.2%). All cases were divided into two groups by symptoms. The proportion of type A dissection(71.4% vs.36.9%) and mortality in hospital(40.0% vs.17.4%) were significantly higher in neurological symptom group than in nonneurological symptom group(P<0.05). All cases were divided into two groups by treatments. Mortality was significantly higher in conservative group(46.8%) than in non-conservative group(14.3%, P<0.05).Conclusions: Painless aortic dissection is a catastrophic disease with high mortality. With the development of diagnosis and treatment, timely diagnosis and treatment helps to improve survival rate.

关 键 词：无痛性主动脉夹层 诊断 治疗 

分 类 号：R54[医药卫生—心血管疾病]