急性主动脉夹层继发急性心肌梗死临床特点及文献分析

Clinical analysis of acute aortic dissection complicated with acute myocardial infarction

目的:探讨急性主动脉夹层(AAD)继发急性心肌梗死(AMI)的临床特点及治疗方案。方法:回顾性分析8例ADD合并AMI患者的临床表现、相关辅助检查资料。结果:本组患者均以胸痛为首发症状,伴有心电图ST-T改变,确诊ADD前均首诊为AMI,1例行急诊冠状动脉造影时确诊,4例行大动脉CT血管造影(CTA)确诊,1例行心脏彩超(UCG)确诊,2例行320排CTA确诊;确诊后均转入心胸外科,手术治疗4例,保守治疗4例,治愈6例,死亡2例。结论:AAD累及冠状动脉和(或)相关因素导致心肌氧供需平衡可继发AMI,临床症状及心电图、心肌酶谱、心肌标志物与原发性AMI不易鉴别,及其容易导致误诊及不恰当治疗,对首诊为AMI的患者,应警惕合并ADD的可能,并完善相关辅助检查予以明确,防止误诊发生。

Objective：To investigate the clinical characteristics and treatment of acute aortic dissection（AAD）complicated with acute myocardial infarction（AMI）.Method：Eight patients of AAD complicated with AMI were retrospectively analyzed.Result：The initial symptom of 8patients was chest pain with ECG ST-T changes,which was misdiagnosed as AMI.Among 8patients of AAD complicated with AMI,one patient was diagnosed by coronary angiography,four patients were diagnosed by CTA,one patient was diagnosed by UCG and 2patients were diagnosed by 320-row CT,respectively.All patients were sent to the department of Cardiothoracic Surgery after diagnosis.Four patients underwent operation and 4were performed with conservative treatment.Six patients cured and 2patients died.Conclusion：AAD can be complicated with AMI due to myocardial ischemia and may mimic AMI due to similarities in risk factors and clinical presentations.If AAD is suspected in a patient with AMI,confirming the diagnosis with the appropriate imaging techniques should be done as quickly as possible,as the consequences of misdiagnosis or delay in diagnosis can be catastrophic.