320例主动脉夹层误诊分析

WT3HZClinical Investigation of 320 Cases of Misdiagnosed Aortic Dissection

目的了解主动脉夹层(Aortic dissection)误诊的现状,提高对AD的诊断的认识。方法采用文献研究方法,通过中国医院数字图书馆(www.chkd.cnki.net)期刊全文数据库检索2000年1月至2009年12月发表的与AD误诊有关的病例研究报告文献40篇,对被误诊的320例AD患者的误诊疾病、临床表现、辅助检查等进行了回顾性调查分析。结果 320例AD患者中高血压病者最多,占258例(80.62%)。临床表现以疼痛发生率为最高(85.00%),胸背痛据首,腹痛为其次。AD B型组的腹痛发生率高于A型组、晕厥发生率低于A型组(均P<0.05)。误诊疾病达30种,前5类依次为冠心病142例(44.38%)、急腹症51例(15.94%)、中枢神经系统病变15例(4.69%)、尿路结石14例(4.38%)、风心病12例(3.75%)。误诊为冠心病组中心绞痛78例、心肌梗死64例;误诊为急腹症组中胰腺炎30例,胆结石和(或)胆囊炎15例、肠梗阻6例;误诊为中枢系统疾病中脑卒中12例、脊髓炎3例。结论 AD患者临床表现复杂,不具备特异性。AD的误诊率高,误诊的疾病种类繁多,应结合影像学检测,可提高诊断率。

Objective To study the present situation of misdiagnosed aortic dissection（AD） and to improve the awareness of the diagnosis of AD.Methods A literature search was performed in Chinese Digital Hospital Library（www.chkd.cnki.net,January 2000 to December 2009）.A retrospective analysis of misdiagnosed disease,clinical manifestations and accessory examinations was carried out on 320 patients with AD（40 papers）.Results Most of the 320 AD patients（258 cases,80.62%） had hypertension.The incidence of pain was highest（85.00%） in the 320 patients.Thoracodorsal pain was the first manifestation and abdominal pain was the second.Compared with patients with type A AD,the incidence of abdominal pain increased and the incidence of apopsychia decreased in patients with type B AD（P〈0.05）.The misdiagnosed diseases reached 30 kinds,and the top five were coronary heart disease（142 cases,44.38%）,acute abdomen（51 cases,15.94%）,central nervous system lesions（15 cases,4.69%）,lithangiuria（14 cases,4.38%） and rheumatic heart disease（12 cases,3.75%）.Among patients misdiagnosed as having coronary heart disease,78 cases were misdiagnosed as angina pectoris and 64 cases as myocardial infarction.Among patients misdiagnosed as having acute abdomen,30 cases were misdiagnosed as pancreatitis,15 cases as cholelithiasis and/or cholecystitis,and 6 cased as ileus.Among patients misdiagnosed as having central nervous system lesions,12 cases were misdiagnosed as stroke and 3 cases as myelitis.Conclusion The manifestations of AD are complicated and have no specificity.The misdiagnosis rate of AD is high and misdiagnosed diseases are various.The diagnosis rate can be increased by combining the imaging examinations in patients with AD.