主动脉壁内血肿19例临床分析

Clinical Analysis of 19 Patients with Aortic Intramural Hematoma

目的总结主动脉壁内血肿的临床特点及诊治措施。方法对经螺旋增强CT检查确诊的主动脉壁内血肿19例的临床资料进行回顾性分析。结果本组19例占同期急性主动脉综合征18.10%,男女比例为5.3∶1.0,年龄为(60.58±7.33)岁。16例有高血压病病史,5例有糖尿病病史,10例合并冠心病。18例以急性胸背痛为首发症状,1例以急性腹痛为首发症状。19例均经螺旋增强CT检查确诊。Sandford A型4例,Sandford B型15例。1例Sandford A型住院行外科手术治疗,1例Sandford A型自行离院,余均住院行药物保守治疗,其中2例Sandford B型行主动脉内覆膜支架置入术。18例住院患者经治疗后均病情好转出院。14例出院后获得随访,随访时间(10.26±4.13)个月,未手术的Sandford A型1例出院3个月后猝死,余均存活。结论主动脉壁内血肿是一种凶险、致死性主动脉急症,临床医师应提高对本病认识,加强重视,以避免误漏诊。早期诊断和个性化治疗是改善主动脉壁内血肿预后的关键。

Objective To summarize clinical characteristics and measures of diagnosis and treatment for aortic intramural hematoma. Methods Clinical data of 19 aortic intramural hematoma patients who had been confirmed by spiral enhancement CT was retrospectively analyzed. Results The rate of 19 aortic intramural hematoma patients had accounted for 18.10% of acute aortic syndrome （AAS） patients during the same period, and male female ratio was 5.3： 1.0. Age of onset was （60.58 ＋-7.33 ） years old. There were 16 patients having a history of hypertension, 5 patients having a history of diabetes mellitus and 10 patients combined with coronary heart disease. Initial symptoms were acute thoracodorsal pain in 18 patients and acute abdominal pain in 1 patient. All the 19 patients were confirmed by CTA. There were 4 patients with Stanford A and 15 patients with Stanford B. One patient with Stanford A had undergone surgery after admission, and second patient with Stan- ford A had left at his free will, while the rest patients had been treated with medicine after admission, In whom 2 patients with Stanford B had been treated with intra-aortic stent insertion. The 18 inpatients were discharged after condition improvement by treatment. A total of 14 patients were followed up after discharge, and the average follow-up time was （ 10. 26 ~ 4. 13 ） months. Among them 1 Stanford A patient without operation died suddenly 3 months after discharge, while the rest patients had survived. Conclusion Aortic intramural hematoma is a dangerous and fatal disease, and therefore clinicians should im- prove knowledge and pay highly attention so as to avoid misdiagnosis, it is the key to improve prognosis by early diagnosis and individualized treatment.