179例主动脉夹层患者的临床资料分析

Analysis of Clinical Records of 179 Patients With Aortic Dissection

目的分析179例主动脉夹层(AD)患者的基本情况、临床特征、误诊和治疗情况。方法对179例AD患者按DeBaKey分型分为Ⅰ型(67例)、Ⅱ型(22例)、Ⅲ型(90例),本组患者中男女之比为4∶1,对其临床资料作回顾性分析。结果在AD患者中有高血压病史的患者547%,其次为长期吸烟、饮酒和马凡综合征。352%的AD患者有发病诱因。AD患者的主要表现为剧烈的胸痛和(或)背痛,Ⅰ型和Ⅲ型者尚伴有腰、腹痛。有318%的AD患者合并心脏受累,包括心肌梗死、心包积液、胸腔积液、主动脉瓣关闭不全和心力衰竭。在经超高速计算机断层摄影术(UFCT)或磁共振成像(MRI)检查证实的患者中,有571%的患者伴有其他血管受累。本组患者中共发生误诊57例,各型间误诊率无显著区别。较多误诊为心绞痛、心肌梗死、胰腺炎、高血压。Ⅲ型AD患者中有544%的患者予内科保守治疗,部分接受外科手术或介入性支架治疗。Ⅰ型896%,Ⅱ型919%的患者行手术治疗。341%的患者联合应用了3种或3种以上的降压药。结论高血压、长期吸烟和饮酒为AD的主要危险因素,其临床表现复杂多变,误诊率高。正确诊断和积极的内科治疗以及根据临床分型和病情采取外科手术、介入治疗可减少病死率和改善患者的预后。

Objectives:To analyse the basic characteristics,clinical features,misdiagnosis and treatment of aortic dissection (AD). Methods:Retrospective analysis of clinical records of 179 patients with AD. Results:The male/female ratio was 4 to 1 The AD incidence rate of hypertension,smoking and drinking in patients with AD was 54 7%,40 3% and 25 5%,respectively.About 30% of patients had a initiation reason for AD. 20% 40% of patients had chest pain and/or back pain,the most frequent initial symptoms. Abdominal and waist pain might occur in typeⅠ and type Ⅲ parients. 31 8% of patients with AD had complications such as myocardial infarction,pericardial effusion,aortic regurgitation or heart failure. Pleural effusion and related vascular complications occurred in 8 9% and 57 1% of the patients. Fifty seven patients were misdiagnosed,with the misdiagnosis rate of 31 8%. There was no difference between these types. The most frequent AD misdiagnoses were cardiac angina,myocardial infarction,pancreatitis and hypertension in this study. Operation rate was 89 6% in typeⅠand 91 9% in type Ⅱgroups. Surgery,interventional stenting and drug therapy were given for 30%,5 6% and 54 4% of patients with type Ⅲ AD. Combination of 3 or more kinds of antihypertensive drugs was used in 34 1% of patients. Conclusion:Hypertension,smoking and drinking are risk factors of AD. Symptoms of AD are complicated and variable,resulting in a high misdiagnosis rate. Surgery,interventional stenting or medical therapy for AD depends on accurate diagnosis,actiue medical therapy or the types of AD.