主动脉夹层临床特点及误诊因素分析

Clinical characteristics of aortic dissection and analysis of factors related to misdiagnosis

回顾分析2003年1月至2008年6月中山医院收治的主动脉夹层361例的临床特点，并着重分析其中误诊的51例资料，探讨误诊相关因素。结果显示，361例患者中男273例，女88例，年龄16—77岁，临床主要表现为疼痛（87．8％）。误诊51例（14．1％），其中男43例，女8例，年龄25—77岁。主要表现为疼痛症状者误诊疾病主要有急性冠状动脉综合征、急性胰腺炎、急性胆囊炎或胆囊结石；主要表现为非疼痛症状者误诊疾病主要为肺部感染、心力衰竭。提示，主动脉夹层临床症状表现多样，易引起误诊；心包积液是诊断主动脉夹层的有利因素。

The clinical data of 361 patients aged from 16 -77 y with aortic dissection （AD） admitted from January 2003 to June 2008, including 273 males and 88 females, were retrospectively reviewed. The symptoms and physical signs of the AD were diverse, major clinical manifestation was pain （87.8%） and the painless diseases were seen in 12.2% of cases. The misdiagnosis occurred in 51 patients （14. 1% ）, including 43 male patients and 8 females, aged from 25 -77 y before admission; 45 painful cases （88.2%） were misdiagnosed as acute coronary syndrome, acute pancreatitis, acute cholecystitis and cholelithiasis and 6 painless patients （ 11.8% ） were misdiagnosed as pulmonary infection and congestive heart failure. The data indicate that AD may demonstrate diverse manifestations and severity leading to misdiagnosis and the symptom of pericardial effusion is helpful for accurate diagnosis.