主动脉夹层症状与原发破口位置、撕裂范围关系的探讨

Investigation on the relationship between symptoms of aortic dissection and location of initial intimal tears or dissection range

目的:探讨主动脉夹层首发症状与内膜原发破口位置和撕裂范围的关系。方法:回顾性总结931例主动脉夹层患者的首发症状、疼痛部位、是否有转移性疼痛、撕裂范围等情况,分析不同症状与原发破口和撕裂范围的关系。结果:疼痛占夹层首发症状的91.2%,其中以胸痛(40.3%)、胸背痛(25.9%)和腹痛(11.7%)最多见,17.6%的患者合并有转移性疼痛。表现为无痛(包括晕厥、胸闷、气短)或仅为胸痛症状的患者以A型夹层多见(均P<0.05)。而以背痛、腹痛、腰痛等为首发症状的多见于B型夹层(均P<0.05),且此类患者的内膜撕裂终点多位于腹主动脉及以下血管,而首发症状为头、颈或咽喉部疼痛的患者夹层撕裂范围多局限于胸降主动脉。结论:主动脉夹层症状呈多样性特点,首发症状与原发破口位置和撕裂范围之间存在规律性,此有助于对急诊疑似主动脉夹层进行初步的诊断。

Objective： To investigate the relationship between the initial symptoms of aortic dissection（ AD） and location of initial intimal tears or dissection range. Methods： The initial symptoms,location of the pain,migration of the pain,classification of AD and dissection range of 931 inpatients with AD were collected. The relationship between symptoms and location of initial intimal tears or dissection range was analyzed. Results： Pain was the major clinical symptom in 91.2% patients. Among them,chest pain was 40.3%,chest and back pain was 25.9%,abdominal pain was 11.7% and migrating pain was 17.6%. Painless（ syncope,chest distress or shortness of breath） or chest pain alone were more commonly seen in type A AD,whereas back,abdominal or lumbar pain were predominant in type B AD（ all P 0.05）. Furthermore,most endpoints of the dissection in patients with back,abdominal and（ or） lumbar pain were located or below the abdominal aorta. In contrast,the tear was located at the thoracic descending aorta when patients suffered with head,neck and（ or） throat pain. Conclusions： Symptoms of AD were diverse. There might be connection between symptoms and location of initial intimal tear or dissection range. Our investigation contributes to the preliminary diagnosis of suspected aortic dissection.