主动脉夹层年轻患者的临床特征

Clinical characteristics of young patients with aortic dissection

目的分析主动脉夹层(aortic dissection,AD)年轻患者的临床特征,提高急诊确诊率。方法回顾分析2007-01至2010-01期间急诊收入的102例AD年轻患者的临床特征及预后。结果 102例AD年轻患者突发胸骨后撕裂样剧痛为95%,有高血压和高血压家族史为83%,吸烟占43%,马方综合征为6%;职业分析工人和农民占70%;多于春冬季发病(62%)。24 h内来就诊患者D-二聚体(D-dimmer,DD)水平较24 h后明显升高(P<0.05)。Logistic回归分析表明,高血压或高血压病史、吸烟和DD水平升高均为年轻AD患者发病的相关因素。结论年轻AD患者的发病症状、职业及危险因素在临床上有其特殊性,诊治中应考虑其特点。

Objective To improve the diagnosis of emergency aortic dissection （AD） by studying the clinical characteristics of young AD patients. Methods The data of 102 cases of AD were obtained from the Emergency Department in the General Hospital of PLA between January 2007 and January 2010. The initial symptoms, history, systolic, diastolic BP, clinical features, D - dimmer, ECG, X -ray findings, echocardiogram and mortality were collected. The effect of treatment with drugs, surgery and intravascular - stent implantation on the prognosis were investigated. Results Sudden chest pain was the first complaint in 95% of the patients. 83% of the 102 AD patients had hypertension and family history of hypertension; those with smoking history and Marfan syndrome accounted for 43% and 6% , respectively. Most of the 102 young AD patients were workers or farmers by trade （ about 75% ）. The onset time was in spring and winter in most cases. The D -dimmer was much higher in 24 hours than over 24 hours （P 〈 0.05 ）. Conclusions By identifying the symptoms, occupation, and risk factors of young AD patients, the identification rate of the AD will increase, and prognosis will improve.