急诊超声在消化道出血合并腹主动脉夹层诊断中的价值

Value of emergency ultrasonography in diagnosis of alimentary tract hemorrhage combined with abdominal aortic dissection

目的探讨消化道出血时急诊超声预示腹主动脉夹层的重要性。方法对2757例急性消化道出血患者行急诊超声检查腹主动脉及其主要分支,对超声发现腹主动脉内中膜增厚或斑块,以及腹主动脉走行扭曲、腹主动脉扩张或腹主动脉夹层等异常者行腹主动脉CTA,将超声与CTA诊断腹主动脉夹层的结果进行对照分析。结果 2575例急性消化道出血患者中,超声提示腹主动脉异常46例,其中腹主动脉夹层10例,腹主动脉斑块26例,腹主动脉扩张7例,腹主动脉扭曲3例。经CTA证实腹主动脉夹层12例,超声准确诊断10例,漏诊2例,其中1例超声表现类似低回声斑块,另1例仅见腹主动脉扩张;其余均与CTA结果一致。所有腹主动脉夹层患者的腹腔干或肠系膜上动脉均开口于假腔。结论急诊超声可及时诊断以消化道出血为主要临床表现的腹主动脉夹层或提供诊断线索;消化道出血时急诊超声须警惕腹主动脉夹层,应仔细扫查腹主动脉及其主要分支,避免漏诊该病造成严重后果。

Objective To investigate the importance of the emergency ultrasonography in diagnosis of abdominal aortic dissection during the alimentary tract hemorrhage. Methods The abdominal aorta and its main branches were detected in 2757 patients with alimentary tract hemorrhage by emergency ultrasonography. The patients that ultrasonography showed abnormity such as abdominal aorta plaque,direction distortion,lumen expansion and abdominal aortic dissection,should be confirmed diagnosis by CTA. The results of emergency ultrasonography and CTA in the diagnosis of abdominal aortic dissection were compared and analyzed. Results In 2575 patients with alimentary tract hemorrhage,ultrasound showed abnormal abdominal aorta in 46 cases, including abdominal aortic dissection in 10 cases, abdominal aortic plaque in 26 cases, abdominal aortic dilatation in 7 cases, abdominal aorta distorted in 3 cases. CTA confirmed that the abdominal aortic dissection in 12 cases, 10 cases of accurate diagnosis of ultrasound, missed 2 cases, of which 1 case of ultrasound showed similar hypoechoic plaque, 1 case showed abdominal aortic dilatation. The remaining patients were confirmed by CTA. The celiac trunk or the superior mesenteric artery in all the abdominal aortic dissection patients open to the false lumen. Conclusion Emergency ultrasonography can be used to diagnose the abdominal aortic dissection timely which with the alimentary tract hemorrhage as the main clinical manifestation,and also offer the diagnostic clues. Must be alert to the abdominal aortic dissection during emergency ultrasonography especially for the patients with alimentary tract hemorrhage,check up carefully the abdominal aorta and its main branches,and avoid misdiagnosis.