晚期妊娠合并急性主动脉夹层八例临床分析

Clinical analysis of eight cases of aortic dissection in the third trimester pregnancy

目的讨论晚期妊娠合并急性主动脉夹层的临床表现、诊断及治疗效果,为临床治疗提供依据。方法回顾性分析2013年11月至2019年5月福建医科大学附属协和医院收治的8例晚期妊娠合并急性主动脉夹层患者的临床资料。结果 8例患者中,6例为Stanford A型、2例为Stanford B型,7例突发胸背部疼痛。6例合并高血压,3例合并马凡氏综合征;5例通过CT血管造影(CTA)联合胸壁超声心动图(TTE)进行诊断,2例行TTE提示主动脉夹层,1例经CTA确诊;8例均行剖宫产终止妊娠,8例新生儿均存活,7例孕妇存活,1例孕妇因感染性休克、多脏器功能衰竭死亡。结论妊娠合并主动脉夹层的危险因素有马凡氏综合征、高血压等,临床表现可为突发胸背部疼痛,CTA和/或TTE可以对其进行诊断,及时的诊断及恰当的治疗是保证母婴安全的重要决策。

Objective To investigate the clinical manifestation, diagnosis and treatment of pregnancy complicated with aortic dissection, and to provide evidence for clinical treatment. Methods The medical records of 8 patients with aortic dissection in the third trimester, who admitted to Fujian Medical University Union Hospital between November 2013 and May 2019, were retrospectively analyzed. Results Among the 8 patients, 6 patients were Stanford type A, 2 patients were Stanford type B, and 7 patients showed chest and back pain. Six patients had hypertension and 3 patients had Marfan syndrome. Computed tomography angiography (CTA) combined with trans-thoracic echocardiography (TTE) was performed in 5 patients, TTE suggested aortic dissection in 2 patients, and CTA was performed in 1 patient. The pregnancy was terminated by cesarean section in 8 cases, and 8 neonates survived, of which 7 pregnant women survived and 1 pregnant woman died of septic shock and multiple organ failure. Conclusion Risk factors for pregnancy complicated with aortic dissection include Marfan's syndrome, hypertension, etc. The clinical manifestations can include sudden chest and back pain, which can be diagnosed by CTA and/or TTE. Timely diagnosis and appropriate treatment are important decisions to ensure the safety of mother and child.