主动脉夹层78例患者的临床特点与疗效分析

Analysis of clinical character and therapeutic effect in 78 cases with aortic dissection

目的探讨主动脉夹层（AD）的易患因素、临床表现，以及诊断和治疗方法，以提高对AD的诊治水平。方法对78例AD患者的临床资料进行回顾性分析，分析其临床特点、辅助检查、影像学诊断、治疗方式及预后。结果①De Bakey分型：Ⅰ型35例（44．8％），Ⅱ型13例（16．7％），Ⅲ型30例（38．5％）。②78例患者临床表现多样，胸痛为常见首发表现，部分病例以并发症为首发表现，误诊率高达38．5％。高血压是导致AD发生的常见原因。③超声心动图、螺旋CT和磁共振成像（MRI）联合应用有助于快速诊断。④治疗早期静脉应用硝普钠，口服美托洛尔，联合其他降压药，病情稳定后行手术或介入治疗。结论内科保守治疗是治疗AD的基础，及时有效的早期诊断和积极采取恰当的治疗是提高AD患者生存率和改善预后的关键。

Objective To investigate the risk factor, clinical manifestation, diagnosis and treatment methods of aortic dissection （AD） and to improve diagnosis and treatment of AD. Methods Clinical data of 78 patients with AD were analyzed retrospectively in our hospital. Results （1）Classification De Bakey： type Ⅰ were 35 cases （44.8%）, type Ⅱ were 13 cases （ 16.7% ）, type In were 30 cases （38.5%）. （2）The onset manifestations varied in 78 patients with AD, but the chest pain was the majority. Misdiagnosis rate was 38.5%.Hypertension is a common cause of AD. （3）Combination of echocardiography, spiral CT and magnetic resonance imaging（MRI） contribute to rapid diagnosis of AD. （4）Early treatment of AD included intravenous nitroprusside, oral metoprolol and combined with other antihypertensive drugs,in stable condition underwent surgery or interventional therapy. Conclusion Conservative treatment is the basis for treatment of AD. Timely and effective accurate diagnosis and active appropriate treatment are the key to increase the survival rate and to improve the prognosis of AD.