主动脉夹层临床诊治及长期预后分析

Clinical diagnosis and treatment and long-term prognosis for aortic dissection

目的探讨主动脉夹层(aortic dissection,AD)的临床表现及诊断、治疗和预后。方法对42例AD患者的临床资料进行回顾性总结。结果高血压是导致AD发生的常见原因,AD患者临床表现多样,胸背部疼痛或腹痛为主要首发症状。增强CT及MRI诊断符合率达100%。AD的治疗包括药物、介入、外科手术。42例患者住院期间7例死亡,4例转院,出院31例患者平均随访26个月,仅1例死亡。结论高血压是AD的主要危险因素,其临床表现复杂多变,误诊率高。DeBaKeyⅠ、Ⅱ型急性期死亡率高,应及早外科手术,DebakeyⅢ型在内科保守稳定的情况下行介入治疗可改善预后。

Objective To explore the clinical features,diagnosis,treatment and prognosis of aortic disseetion（AD）. Methods A ret- rospective analysis was made of clinical records of 42 patients with AD. Results Hypertention was the most important cause of AD. The clinical symptoms of the 42 cases were diverse. The severe pain of chest and back was a common initial symptom. The coincidence rates of diagnosis with enhanced CT and MRI were 100 percent There were medical,surgery or interentional stenting therapy for AD. Seven patients died in hospitalization and 4 patients were trans^ered to superior hospitals. 31 patients were followed up for average 26 months, at last,only one patient died. Conclusions Hypertention was the most important cause of AD. Symptoms of AD are complicated and variable. There is a high misdiagnosis rate for AD. DeBakey Type I and Ⅲ patients have a high mortality in the acute phase,therefore surgical treatment should be made as soon as possible. Progrosis can be improved in Debakey type Ⅲ patients by receiving interention- al stenting therapy after stability.