急性主动脉综合征108例临床特征分析

Clinical Characteristics of Acute Aortic Syndrome:Report of 108 Cases

目的探讨急性主动脉综合征的临床特征、诊断及治疗效果。方法回顾性分析北京大学人民医院2004—2009年108例诊断为急性主动脉综合征患者的住院资料。结果 108例急性主动脉综合征患者中主动脉夹层91例(84.3%),穿透性主动脉溃疡9例(8.3%),主动脉壁间血肿8例(7.4%)。病变累及升主动脉37例(34.3%),累及降主动脉71例(65.7%)。108例患者中高血压和不规则用药97例(89.8%),有高血压病史67例(62.0%)。疼痛是本组急性主动脉综合征患者的主要临床表现,有疼痛症状者99例(91.7%),其中扩展性和(或)转移性疼痛72例,表现为撕裂样疼痛17例、无疼痛症状9例。就诊时心率>100次/min 94例(87.0%)。本组患者保守治疗20例,死亡8例,手术治疗88例,死亡13例;其中近端主动脉病变手术死亡11例;远端主动脉病变主要采用腔内覆膜支架介入治疗,死亡2例。结论转移性疼痛是急性主动脉综合征的特征性表现,血压和心率变异性与其发病有关,远端主动脉病变可采用介入治疗。

Objective To analyze the clinical characteristics of acute aortic syndrome and its diagnosis and treatment effect. Methods The clinical data of 108 in - patients with acute aortic syndrome admitted to this hospital from January 2004 to December 2009 were analyzed. Results In 108 patients, 91 had aortic dissection （84. 3% ）, 9 penetrating atherosclerotic aortic ulcer （8.3%）, 8 intramural aortic haematoma （7.4%）, 37 lesion - involving ascending aorta （34. 3% ）, 71 descending aorta （65.7%）. Ninety -seven had hypertension and irregular medication （89. 8% ）, 67 had hypertension history （62. 0% ）. Pains were the main clinical manifestations, 99 had pain symptoms （91.7%）, thereinto 72 had expansible and （or） transitive pains, 17 tearing - like pains, 9 had no pains. Ninety - four patients had heart rate of 100times/min （87.0%）. Twenty patients had conservative therapy, 8 died; 88 had surgical treatment, 13 died. Conclusion Transitive pains are the characteristic manifestations of acute aortic syndrome. Blood pressure and heart rate variability are related to its development. Distal - end aorta lesions can be given interventional therapy.