摘要
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.
出处
《内科急危重症杂志》
2016年第3期176-179,共4页
Journal of Critical Care In Internal Medicine
基金
国家自然科学基金青年基金(No:81400977)
关键词
急性主动脉夹层
急性缺血性卒中
临床特点
诊断
Acute aortic dissection
Acute ischemic stroke
Clinical feature
Diagnosis