酷似急性心肌梗死的主动脉夹层临床特征分析

Aortic Dissection Mimicking Acute Myocardial Infarction

【目的】探讨累及冠脉的急性主动脉夹层的临床特点,避免误诊、误治,及时采取正确的治疗手段。【方法】回顾性分析12例酷似急性心肌梗死的主动脉夹层的病例资料及转归。【结果】同期288例主动脉夹层患者中,累及冠脉致急性心肌梗死12例,其中2例(16.7%)为下壁心肌梗死,1例(8.3%)为前壁心肌梗死,9例(75%)为非ST段抬高性心肌梗死;男性发病明显高于女性,男女比例约3∶1。年龄43～76(56.9±12.2)岁。8例(66.7%)患者既往有高血压病。11例(91.7%)患者有不同程度的胸痛而入院,伴背痛9例(75%),晕厥4例(33.3%),低血压6例(50%),烦躁不安7例(58.3%)。实验室心肌酶学均阳性,D-二聚体(18.95±1.83)μg/mL;3例行冠脉造影未发现冠脉开口;经胸心脏超声及胸部CTA明确夹层的识别率为100%。其中3例行外科手术,1例术后24 h内死亡,2例存活。平均随访5 h至12个月,2例(16.7%)存活,10例(83.3%)患者死亡。【结论】主动脉夹层致急性心肌梗死在临床上较少见,但其病情危重,死亡率高,且极易误诊,预后差,早期明确诊断,及时手术可改善预后。对于心肌梗死合并背痛,烦躁不安及D-二聚体异常升高时要高度怀疑本病。

【Objective】To explore the clinical characteristics of aortic dissection involved in coronary artery in order to avoid misdiagnosis,mistreatment,and take correct treatment methods in time.【Methods】Twelve cases of aortic dis.section(AD)manifesting as acute myocardial infarction(AMI)were analyzed retrospectively and followed up.【Results】A total of 12 cases were enrolled from 288 cases of AD patients,of which 2 cases(16.7%)were inferior wall myocardial infarction,1 cases(8.3%)were anterior wall myocardial infarction,9 cases(75%)were non ST segment elevation myo.cardial infarction,male patients was significantly predominant over female,leading to the male/female ratio of 3∶1,the age was 43~76(56.9±12.2)years.Up to 66.7%of patients had a history of hypertension.11 patients(91.7%)were ad.mitted to hospital for different degrees of chest pain,with back pain in 9 cases(75%),syncope in 4 cases(33.3%),hy.potension in 6 cases(50%),and irritability in 7 cases(58.3%).All the myocardial enzymes were positive in the labora.tory and significantly elevated D-dimer;3 cases were performed coronary arteriography but not found the opening of coro.nary artery.AD was confirmed by transthoracic echocardiography and chest CTA.3 cases of surgery were performed,1 cases failed and died within 24 hours,and 2 cases were successful.The average follow-up 5 hours to 12 months,2 cases survived and the remaining 10 cases died.【Conclusions】Myocardial infarction caused by aortic dissection is rare in clin.ic,but it has critical and high mortality rate,and it is easily misdiagnosed,with poor prognosis.Early diagnosis and timely operation can improve the prognosis.In the case of AMI with back pain,irritability,and abnormal rise of D two polymer,the disease should be highly suspected.