急性主动脉夹层动脉瘤早期诊断(附21例临床分析)

Research on early diagnosis of acute aortic dissecting aneurysm

目的:探讨急性主动脉夹层动脉瘤(aortic dissecting aneurysmADA)患者的临床特征。方法:回顾分析21例急性患者的临床资料,判断影响早期诊断的主要因素。结果:21例急性患者中男女之比为3.2/1(16/5);17例(80.95%)表现为剧烈的疼痛(胸痛,腹痛,腰背痛);发病时血压明显升高14例(66.66%);四肢血压不对称或一侧肢体脉搏消失3例(14.28%);可闻及心脏或周围血管杂音8例(38.09%);血清酶学阳性改变2例(9.52%);心电图(ECG)改变15例(71.42%);胸部X线片阳性变化105例(75.15%)。结论:急性临床表现复杂,出现心脏或周围血管杂音,四肢血压不对称或一侧肢体脉搏消失,胸部X线片阳性变化和剧烈的疼痛是明确ADA较有意义的指标,掌握其临床特征是提高早期诊断的关键。

Objective To evaluate the clinical characters of acute aortic dissecting aneurysm（ADA）.Method Twenty-one patients suffering from acute ADA were analyzed retrospectively.The main factors for diagnosis in early stage were evaluated.Results The ratio between male and female was 3.2：1（16 /5） ;severe pain（located in chest,abdomen or lower back） was the most common presenting symptoms which were presented in 17 cases（80.95%） and hypertension was found in 14 patients（66.66%）.Other symptoms included asymmetrical blood pressure or unilateral disappeared pulse（14.28%）,heart murmur or peripheral vessels murmur（38.09%）,changes in chest X-ray,ECG and serum enzymes were also found.The proportion was 75.15%,71.42% and 9.52%,respectively.Conclusion The symptoms of acute ADA is complex.ADA should be considered strongly in all the patients presenting acute sudden chest pain,heart murmur,peripheral vessel murmur,asymmetrical blood pressure,unilateral disappeared pulse,changes in chest X-ray,etc.To familiar with typical clinical symptoms is the key of diagnosis in early stage.