急诊抢救室血D―二聚体浓度对急性主动脉夹层诊断价值.docVIP

急诊抢救室血D―二聚体浓度对急性主动脉夹层诊断价值 　　[摘要] 目的 探讨急诊抢救室查血D-二聚体浓度检测对诊断或排除急性主动脉夹层的临床价值。 方法 回顾性研究50例以“胸痛”为主诉，后经心脏超声、血管CTA、MRI或血管造影确诊的急性主动脉夹层患者，并选择同时期在急诊确诊为急性ST段抬高型心肌梗死的50例患者作为对照组。患者进入急诊抢救室时抽血检测D-二聚体、肌钙蛋白I水平。 结果28例主动脉夹层患者为Stanford A型，22例B型。所有主动脉夹层患者D-二聚体水平升高（5000?g/L），均值（9500±3200）?g/L（5500～14 460?g/L），敏感性100%。自症状发作到D-二聚体测定的时间为1h～4d，D-二聚体升高的程度与病程呈负相关（r=-0.93，P=0.00）。病变范围越大，D二聚体水平越高，死亡组D-二聚体均高于10 000?g/L，提示D-二聚体升高对判断预后有指导价值。与急性主动脉夹层患者相比较，仅有7例急性ST段抬高型心肌梗死患者的血D-二聚体水平升高，且升高不明显（3000?g/L）。 结论 血D-二聚体阳性且达到一定水平有助于在急诊早期诊断或排除急性主动脉夹层。血D-二聚体升高对判断病变范围和预后有一定的指导价值。 　　[关键词] 急诊抢救室；急性主动脉夹层；血D-二聚体；急性ST段抬高型心肌梗死；诊断价值 　　[中图分类号] R543.1 [文献标识码] A [文章编号] 2095-0616（2015）24-16-05 　　[Abstract] Objective To explore the clinical value of plasma D-dimer level detection in diagnosis or exclusion of acute aortic dissection in emergency department. Methods 50 patients with complaint of “pain chest” who were diagnosed as acute aortic dissection by cardiac ultrasound，vascular CTA， MRI or angiography were retrospectively analyzed.50 patients who were diagnosed as acute ST-Segment elevation myocardial infarction at the same time were selected as the control group.Patients were received hemospasia to detect D-dimer and cardio tropnin I level when they were sent into emergency department. Results 28 patients had type A acute aortic dissection and 22 patients had type B acute aortic dissection. Plasma D-dimer levels of all cute aortic dissection patients were improved（5000?g/L）and the average value was（9500±3200）?g/L（5500-14460?g/L）.The sensitivity was 100%.Time from onset of symptoms to D-dimer detection was 1h-4d.Degree of D-dimer improvement was negatively related to duration of diseases（r=-0.93，P=0.00）.The larger the lesion range was， the higher the D-dimer level was.D-dimer levels of the death group were all higher than 10000?g/L，showing that increased D-dimer level was of guidance value for predicting diagnosis.Compared with acute aortic dissection patients，plasma D-dimer level of 7 patients with acute ST-Segmen