急性主动脉夹层合并急性缺血性卒中10例临床特点分析

Analysis of clinical characteristics of 10 cases with acute aortic dissection complicated with acute ischemic stroke

目的:探讨急性主动脉夹层(AAD)合并急性缺血性卒中(AIS)的临床表现、诊断及治疗。方法:回顾性分析10例AAD合并AIS患者的临床病历资料。结果:10例患者主动脉夹层均为Stanford A型,其中5例病程中未出现胸腹部疼痛,4例以突发昏迷、6例以其它神经系统症状起病。脉搏短绌(80%)、双侧血压不对称(70%)、血压正常或降低(70%)是相对常见的体征。患者分别通过CT血管成像(60%)、经胸壁超声心动图(50%)、胸部CT(30%)确诊为主动脉夹层。头颅CT或MRI多呈现急性大面积脑梗死,其中以右侧颈内动脉系统脑梗死多见(60%)。所有患者的血浆D-二聚体浓度均显著高于正常值。1例患者接受急诊外科手术治疗并预后良好,其余9例仅行药物治疗,其中4例患者死亡,5例自动出院。结论:AAD合并AIS病情重,病死率高,结合临床表现、影像学及实验室检查有利于快速诊断;急诊外科手术是首选的治疗措施。

Objective： To explore clinical manifestation,diagnosis and treatment of acute aortic dissection（ AAD） complicated with acute ischemic stroke（ AIS）. Methods： Clinical data of 10 patients with AAD complicated with AIS were analyzed retrospectively. Results： All patients were classified as Stanford type A AAD. 5 patients had no complain of chest pain in the course of the disease. 4 cases started with abrupt coma and 6 cases with other neurological symptoms. Pulse deficit（ 80%）,asymmetric blood pressure（ 70%）,normal or low blood pressure（ 70%） were relatively common signs. AAD was diagnosed by computed tomography angiography（ CTA,60%）,transthoracic echocardiography（ TTE,50%） and chest CT scanning（ 30%）. Most patients showed acute massive cerebral infarction on head CT or magnetic resonance imaging（ MRI）,60% of them with the infarction in the territory of right internal carotid. The concentration of D-dimers in all patients was significantly higher than the normal values. One patient received urgent surgical repair of AAD which resulted in a favorable prognosis,while the remaining 9 underwent only medical treatment,among whom 4 patients died,5 gave up and discharged. Conclusions： AAD complicated with AIS is a serious condition with high mortality. Combined with clinical presentation,radiological and laboratory examination is beneficial to rapid diagnosis. Emergency surgery is the preferred treatment.