160例急性主动脉夹层患者的临床分析及护理

Clinical analysis and emergency nursing of acute aortic dissection： 160 cases

目的探讨急性主动脉夹层的临床特征、诊治方法及有效的护理措施。方法统计并分析2011年10月～2014年12月徐州医学院附属医院收治的160例急性主动脉夹层患者的临床影像和护理资料，包括症状、影像学诊断结果、治疗情况、出院状态和护理措施等。结果160患者中行超声心动图检查78例，确诊65例（83．3％）；行CT检查27例，确诊25例（84．6％）；行MRI检查35例，确诊32例（94．1％）。StanfordA型49例（30．6％），StanfordB型111例（69．4％）。手术治疗38例，死亡23例（60．5％）；保守治疗122例，死亡8例（6．6％）。总体死亡31例（19．4％，31／160），其中StanfordA型死亡26例（53．1％），StanfordB型死亡5例（4．5％），StanfordA型病死率明显高于StanfordB型（X2=51．35，P〈0．01）。缓解或治愈129例（80．6％，129／160），其中StanfordA型治愈或好转23例（46．9％，23／49），StanfordB型治愈或好转t06（95．5％，105／111），StanfordB型治愈或好转率明显高于StanfordB型（X2=42．40，P〈0．01）。160例患者均采用密切观察对症护理和心理护理。结论与超声心动图、CT比较、MRI确诊率最高，早期诊断和治疗是降低病死率的关键。护理上密切注意患者症状变化，及时采取针对性治疗可提高患者抢救成功率。

Objective To explore the clinical features, treatment methods and effective nursing strategies of acute aortic dissection. Methods A total of 160 patients admitted into the Affiliated Hospital of Xuzhou Medical College from October 2011 to December 2014 due to acute aortic dissection were included into the current study. Their clinical data were collected, such as symptoms, radiological results, therapeutic regimen, discharge status, and nursing strategies. Results There were 78 patients undergoing ultrasound examination, in which 65 ones were diagnosed （83.3%）; 27 patients subjected to CT examination, in which 25 ones were diagnosed; 35 patients having MRI, in which 32 ones were diagnosed （94.1%）. Among the patients were 49 ones with Stanford type A （30.6%） and 111 ones with Stanford type B （69.4%）. There were 39 patients who were treated with surgery, with 23 cases of dead （60.5%）, in contrast with 122 patients receiving conservative treatment, with 8 cases of death （6.6%）. Totally 31 patients died （31/160, 19.4%）, including 26 Stanford type A patients （53.1%） and 5 Stanford type B patients （4.5%）. The number of death was remarkably higher for Stanford type A patients than those with type B （X2=51.35, P〈 0.01）. There were 129 patients who were cured or relieved （80.6%, 129/160）, including 23 Stanford type A patients （46.9%, 23/49） and 106 type B patients （95.5%, 105/111）. The rate of curing or obvious remission was markedly higher for Stanford type B patients than those with type A （X 2=42.40, P〈0.01）. Close observation and careful nursing were used for all patients. Conclusion MRI shows the highest rate of diagnosis for acute aortic dissection patients, compared with US and CT. Early diagnosis and treatment are the key points to reduce mortality. Close observation, carefully nursing and emotional management are important factors to improve survival rate.