主动脉夹层猝死患者的临床与尸检病理分析

Pathological and clinical analysis of sudden death due to aortic dissection

目的探讨主动脉夹层(AD)患者猝死的原因、临床特点、病理基础,从而早期诊断,有效防治。方法回顾性分析8例AD猝死患者的临床尸检病理资料,结合文献探讨其发生、病理学改变、与死亡的关系以及检查方法和诊断要点。结果 AD临床表现复杂多样。病理特点为夹层壁内平滑肌细胞明显退行性变、弹力纤维减少或断裂、胶原纤维增生等改变。死亡原因:急性心包填塞6例,休克2例。结论 AD起病隐匿,但其一旦破裂或撕裂,则发病急骤,常导致严重后果。尽早防治动脉粥样硬化,有效控制高血压是预防AD的根本措施。

Objective To investigate the clinical features, pathological bases and causes of sudden death in patients with aortic dissection（AD） for earlier diagnosis along with earlier effective intervention. Methods Retrospectively analyzed the clinical and pathological archives of 8 cases of sudden death with AD, whose occurrence, pathological type, relationship with death, as well as inspection methods and diagnostic criteria were studied and literature related was reviewed. Results The clinical manifestations of AD were complicated. The detected results showed the retrograde degeneration of smooth muscle cell, the reduction or breaking of elastic fibers and proliferation of collagen fibers , etc. in AD wall. The causes of sudden death included acute perieardial tamponade in 6 cases and shock in the other 2 cases. Conclusions Insidious onset of AD may result into emergency once aortic interlamellar being ruptured unexpectedly, which was rather dangerous and caused sudden death uhimately. The fundamental measure for prevention of AD is properly treatment for atherosclerosis and hypertension.