主动脉夹层40例首诊情况及内科治疗研究.docVIP

主动脉夹层40例首诊情况及内科治疗研究【摘要】 目的 探讨主动脉夹层的首发临床特点和内科治疗经验，以减少致命误诊。 方法 回顾性总结2003年1月至2010年6月本院收治的40例主动脉夹层患者的诊疗经过。结果 40例患者中以老年男性且有高血压病史为主，多在血压控制不良合并诱因刺激下发病。首发症状以胸痛为主，首诊正确率仅20%。接受内科治疗的患者中，总好转率为40%，无效自动出院的40%,死亡率20%。结论 主动脉夹层是内科的极危急重症，但首诊误诊率高，在临床中碰到急起胸背部剧痛、伴有虚脱表现，血压下降不明显甚至升高、脉搏血压不对称或消失、主动脉瓣杂音的患者时要高度怀疑主动脉夹层。在稳定生命体征的前提下，快速进行床边心电图、胸片结合B超、D 二聚体、心肌酶谱等必要检查快速诊断，再视病情选择超声心动图、螺旋CT和或MR血管造影的检查组合明确诊断。在治疗上，一旦疑诊就要迅速进行以内科治疗为基础的综合治疗，根据患者病变特点结合家属意愿选择确定个体化的治疗方案。 【关键词】主动脉夹层；首诊；内科治疗 Analysis of the first clinical features and medical treatment of 40 aortic dissection cases CAI Min， PAN Wei， LI Wei rong. Department of Cardiology,Shanshui Hospital Affiliated to Guanzhou Medical College,Guangzhou 523808,China 【Abstract】 Objective Discuss the first clinical features of aortic dissection and medical treatment experiences in order to reduce fatal misdiagnosis。 Methods Retrospectively summarized the process of the diagnosis and treatment of the 40 aortic dissection cases that in our hospital from January 2003 to June 2010. Results The 40 patients were mainly old males, they also had a history of hypertension. The disease was spurred mostly in the condition that blood pressure was poorly controlled, with certain incentives. The first symptoms were mainly chest pain and the first diagnosis was only 20% correct. In the patients who received medical treatment, the total improvement rate was 40%, the rate of ineffective treatments and voluntary leaving the hospital was 40%, and the death rate was 20%.Conclusion Aortic dissection is a very critical and severe disease, but the misdiagnosis rate of first diagnosis was high. When the patient had sudden and severe chest and back pain with symptoms of collapse, or his blood pressure dropped slightly or even increased, or his pulse pressures were not same or disappear, or he had aortic valve murmur, aortic dissection should be highly suspected. In the premise of stable vital conditon, ECG bedside, chest X ray, Brightness mode, D dimer and myocardial enzym