主动脉夹层急诊诊断与不同时期误诊分析

Diagnosis and Misdiagnosis of Aortic Dissection

目的探讨主动脉夹层(AD)的临床特征、急诊诊断和误诊原因。方法分析65例AD患者的临床表现、实验室检查、心电图、X线片、超声心动图、多层螺旋CT血管成像(MSCTA)、核磁共振成像(MRI)检查结果;并将1999年7月-2003年6月收治的AD病例分为Ⅰ组,将2003年7月-2007年6月收治的AD病例分为Ⅱ组,分析2组的误诊情况。结果65例AD患者临床表现多种多样。超声心动图、MSCTA、MRI对AD的诊断准确率分别为60.5%、97.5%、100%。Ⅰ组误诊率为57.9%,明显高于Ⅱ组误诊的26%(P<0.05)。结论AD临床表现复杂多变,容易误诊。对AD认识不足,体格检查不全面,未及时行相关影像学检查是早年误诊的原因,部分患者以并发症为首发症状是近年来误诊的主要原因,应引起急诊医师的高度重视。

Objective To study the clinical character,diagnosis and causes for misdiagnosis of aortic dissection （AD）. Methotis The symptoms, physical signs, results of laboratory test, electrocardiogram, X-ray pictures, ultrasonic cardiogram （ UCG）, multi - slice CT angiography （MSCTA） and magnetic resonance imaging （MRI） of 65 patients with AD were analyzed. In order to find out the causes of misdiagnosis in different time,all patients were divided into two groups. Group 1 was patients who were treated in emergency department from July 1999 to June 2003, while group 2 was from July 2003 to June 2007. Results The Symptoms and physical sign of AD were different in 65 patients. The accuracy of UCG, MSCTA, MRI in diagnosing AD was 60. 5% ,97.5% and 100%. The misdiagnosis rate in group 1 was 57.9% ,while in group 2 was 26%. The difference between two groups was significant （P 〈 0.05）. Conclusions The symptoms and physical signs of AD were complex and it was easy to be misdiagnosed. The causes of misdiagnosis in early time were insufficient understanding of the disease,physical examination carelessly and did not perform imaging examination in time. While some patients manifest complications firstly was the cause for misdiagnosis in resent years. So the emergency doctors should pay more attention to AD.