急性主动脉综合征30例临床分析

A clinical analysis of thirty cases with acute aortic syndrome

目的探讨急性主动脉综合征(AAS)的临床特征。方法回顾性总结30例AAS患者的临床资料并分析其临床特征。结果30例AAS中,主动脉夹层28例,主动脉壁内血肿和胸主动脉瘤破裂各1例;77%为老年男性;57%有高血压病史;90%有胸痛症状,可向腰、背和腹部放射;91%磁共振成像(MRI)检查阳性;20%行外科手术治疗,均存活;住院病死率23%。结论AAS以主动脉夹层为主,尚包括主动脉壁内血肿、穿透性粥样硬化性主动脉溃疡和症状性主动脉瘤。后三者临床特征与主动脉夹层相似。MRI能明确显示AAS中4种不同病变,与其他检查手段相比其诊断敏感性和特异性最强;AAS依据病变部位不同采取相应的治疗原则——近端病变以外科手术为主,远端病变则以内科保守治疗主为。

Objective To analyze the clinical characteristics of acute aortic syndrome. Method The clinical data of thirty patients with acute aortic syndrome were retrospectively collected. Their clinical characteristics were summarized. Results Among thirty cases, twenty-eight cases were diagnosed as having aortic dissection,one case as intramural aortic haematoma and one case as thoratic aortic aneurysm rupture. Old men accounted for 77% of the patients. 57% of the patients had hypertension. The chest pain existed in 90 % of the patients, some of which may radiate into the waist, back and abdomen. 91% of the patients had positive results by MRI. 20% of the patients underwent surgical treatment and were all living. The in-hospital mortality rate was 23%. Conclusions Acute aortic syndrome should include aortic dissection, intramural aortic haematoma, penetrating atherosclerotic aortic ulcer and aortic aneurysm rupture. They have similar symptoms. MRI can be used to diagnose acute aortic syndrome. Its sensitivity and specifity are higher than other imaging techniques. Different treatment should be done according to different aortic segment involved. Patients with proximal lesion mainly undergo surgical treatment. While the patients with distal lesion mainly undergo medical treatment.