主动脉夹层分离30例临床分析

Clinical analysis of 30 cases on aortic dissecting

目的分析主动脉夹层(aortic dissection,AD)的临床特征,以提高对AD的诊治水平.方法对1995～2004年经临床诊断证实的30例AD患者的临床资料进行回顾性分析,并根据患者的发病年限分为第1组(1995～2000年)14例,第2组(2000～2004年)16例,比较两组的诊断时间及预后.结果 AD病变范围变化大,临床表现错综复杂.以多部位的剧烈疼痛为首发症状26例,发病时血压升高23例,主动脉瓣区新出现的舒张期杂音7例,腹部血管杂音5例,29例经CT或磁共振确诊.第2组的24、72小时确诊率分别为38%、50%,与第1组的7%、14%比较有统计学差异(P<0.05),首诊到确诊的中位时间第2组2日,第1组8.5日.结论多部位剧烈疼痛伴高血压和主动脉瓣区新出现的舒张期杂音、腹部血管杂音应高度疑AD.确诊应充分依靠CT或磁共振,磁共振优于CT.镇静、止痛、控制血压、心率、抑制心肌收缩力是治疗的关键,手术治疗可降低病死率.

Objective： The clinical features of aortic dissecting（AD） are analyzed for the purpose to improve the practical diagnosis and treatment of AD. Methods： The clinical features of 30 cases of clinically confirmed aortic dissecting are analyzed, and the patients are divided into two groups according to the number of years that AD happened to them： group I （1995-1999）, 14 patients; groupll （2000-2004）,16 patients. Diagnosis time and prognosis are compared between the two groups. Results： The pathological range of AD varies greatly, and clinical manifestations are complicated. Multi-position severe ache is found in 26 cases as initial symptom. Blood pressure rises in 23 cases. New diastolic murmur in aortic area is found in 7 cases. Abdominal vascular murmur is found in 5 cases. 29 cases are diagnosed by CT scanning or MRI scanning, and 1 by autopsy. Confirmed diagnosis rate in 24 hours and 72 hours improves significantly （p〈0.05）. The average time before diagnosis is shortened by 5 days（p〈0.05）, case fatality rate decreased by 15%（p〉0.05）. Conclusion： Patients with multi-position severe ache and hypertension and/or new diastolic murmur in aortic area, abdominal vascular murmur should be highly suspected for the diagnosis of AD. Confirmed diagnosis is largely dependent on CT scanning or MRI scanning which is superior to the former. Sedation, alleviating ache, controlling blood pressure and heart rate, inhibit cardiac contractility are the keys of treatment. Surgical therapy can bring down the case fatality rate.