疑似急性肺动脉栓塞的A型主动脉夹层1例并文献复习  

A case of type A aortic dissection suspected of acute pulmonary embolism and literature review

作　　者：张文辉[1] 侯磊 秦一杰 ZHANG Wenhui;HOU Lei;QIN Yijie(Intensive Care Unit,People's Hospital of Rizhao,Rizhao 276800,China)

机构地区：[1]日照市人民医院重症医学科,山东日照276800

出　　处：《临床医学研究与实践》2024年第27期1-4,共4页Clinical Research and Practice

摘　　要：本院收治1例以胸痛、胸闷就诊的患者,入院时心脏超声及CT检查提示主动脉夹层可能,但患者存在严重低氧血症[动脉血氧分压/吸入氧气分数比值(PaO_(2)/FiO_(2))<200mmHg]、右心负荷增加表现,同时符合急性肺动脉栓塞的临床表现,进一步完善计算机断层扫描血管造影(CTA)检查,见主动脉夹层形成的巨大假性动脉瘤压迫肺动脉主干,术中经影像学也进一步得到证实。该患者的缺氧表现实际为主动脉夹层动脉瘤局部压迫引起肺动脉狭窄所致。此病例较为罕见,临床上应注意借助辅助检查手段迅速鉴别,以免漏诊、误诊造成严重后果。A patient with chest pain and chest tightness was admitted in our hospital.Cardiac ultrasound and CT examination on admission indicated the possibility of aortic dissection,but the patient had severe hypoxemia[arterial partial pressure of oxygen/fraction of inspired oxygen in nitrogen(PaO_(2)/FiO_(2))<200 mmHg]and increased right heart load,and was consistent with the clinical manifestations of acute pulmonary embolism.The computed tomography angiography(CTA)examination was further improved,and a huge pseudoaneurysm formed by aortic dissection compressed the main pulmonary artery,which was further confirmed by imaging during the operation.The hypoxia in this patient was actually caused by local compression of aortic dissection aneurysm leading to pulmonary artery stenosis.This case was relatively rare,clinical attention should be paid to rapid identification with auxiliary examination means to avoid missed diagnosis and misdiagnosis caused serious consequences.

关 键 词：主动脉夹层 急性肺动脉栓塞 低氧血症 计算机断层扫描血管造影 

分 类 号：R563.5[医药卫生—呼吸系统]