以腹痛为首发症状的急性主动脉夹层误诊为急性胰腺炎原因分析

Analysis of Causes of Acute Aortic Dissection Misdiagnosed as Acute Pancreatitis with Abdominal Pain as the First Symptom

目的加强临床医生对急性主动脉夹层临床特点的认识,总结误诊原因。方法回顾性分析2015年1月—2016年12月我院收治的以腹痛为首发症状的误诊为急性胰腺炎5例的急性主动脉夹层病例资料。结果本组占同期收治急性主动脉夹层患者的10.42%(5/48)。5例均因上腹部疼痛、恶心和呕吐入院,其中似刀割样疼痛且向背部放射4例,伴腹胀2例,伴头晕、晕厥各1例,血清淀粉酶均升高(2000~2500 U/L)。病初均误诊为急性胰腺炎,给予相应治疗病情未见明显改善,且3例病情加重,遂完善相关检查,经CT、超声心动图等检查确诊为急性主动脉夹层,其中Stanford A型2例、B型3例,误诊时间3~10 d。确诊后1例因抢救无效死亡,4例予保守治疗病情好转出院,预后良好。结论急性主动脉夹层缺乏特异性的临床表现,临床医生应加强对本病的警惕性和认知能力,减少误诊的发生,改善患者预后。

Objective To understand the clinical features of acute aortic dissection(AD),and to summarize the causes of misdiagnosis,thereby improving the diagnosis and treatment of the disease.Methods A retrospective analysis of 5 patients with acute AD misdiagnosed as acute pancreatitis with abdominal pain as the first symptom was performed in our hospital from January 2015 to December 2016.Results Patients in our group accounted for 10.42%(5/48)of all patients diagnosed as having acute AD in the same period.Five patients were admitted to our hospital for upper abdominal pain,nausea and vomiting,including 4 accompanied with knife-like pain and radiation to the back,2 with bloating,1 with dizziness and 1 with syncope Their serum amylase was elevated(2000-2500 U/L)for which all were misdiagnosed initially as acute pancreatitis.After the appropriate treatment,no significant improvement was observed,and the condition was aggravated in 3 patients.Therefore,additional examinations were performed,including CT,and echocardiography,which confirmed the diagnosis of acute AD.Among them(2 cases of Stanford type A and 3 cases of type B),duration of misdiagnosis was 3 to 10 days.After the diagnosis,a patient died after ineffective rescue,4 patients were discharged from hospital after the condition was significantly improved by conservative treatment for 6 to 15 days.All patients had favorable prognosis.Conclusion Given atypical clinical manifestations of acute AD,clinicians should strengthen vigilance and enhance the understanding of the disease to reduce or avoid misdiagnosis,thus improving the prognosis of patients.