床旁急危症超声在急性主动脉夹层中的应用

Application of Emergency Bedside Ultrasonography for Acute Aortic Dissection

目的探讨床旁急危症超声在诊断以胸痛为主要表现的急性主动脉夹层(acute aortic dissection,AAD)中的应用价值。方法回顾性分析我院2017年9月至2020年6月行床旁急危症超声检查并最终确诊为AAD的147例患者的临床资料。其中,Stanford A型97例,急诊手术治疗64例;Stanford B型50例,急诊行主动脉夹层覆膜支架植入术45例。结果本组147例患者均行床旁急危症超声检查并经CTA最终确诊AAD,其中经急危症超声检出136例,占同期因胸痛行急危症超声患者的21.66%(136/628),与CTA比较诊断符合率为92.52%,其中Stanford A型为96.91%(94/97),B型为84%(42/45)。Stanford A型患者围手术期死亡22例(22.68%),B型患者围手术期死亡2例(4%)。床旁急危症超声检出主动脉内光带飘浮或双腔改变、升主动脉内径增宽>42 mm、主动脉瓣反流和心包积液,在Stanford A型患者中分别为82.47%、63.92%、78.35%和38.14%,在Stanford B型患者中分别为84%、2%、46%和10%;Stanford A型和B型的敏感性(出现至少一项上述声像改变)分别为96.91%和84%。结论床旁急危症超声有助于早期快速诊断AAD,可作为首选诊断工具。

Objective To explore the value of emergency bedside ultrasonography for the diagnosis of acute aortic dissection(AAD)with major manifestation of chest pain.Methods The clinical data of 147 cases underwent bedside emergency ultrasonography and finally diagnosed as AAD from September 2017 to June 2020 were analyzed retrospectively,including of 97 cases of Stanford type A and 50 cases of Stanford type B.Emergency surgical interventions were performed in 64 cases of Stanford A,and emergency covered stent implantation were carried out in 45 cases of Stanford B.Results All 147 patients underwent emergency bedside ultrasound examination and finally diagnosed with AAD by CTA.Among them,136 AAD cases were detected by emergency ultrasonography,and accounting for 21.66%(136/628)of chest pain cases during the same period.The total diagnostic coincidence rate was 92.52%,in which Stanford type A was 96.91%(94/97)and Stanford type B was 84%(42/45).The peri-operative mortality was 22.68%in Stanford A and 4%in Stanford B.The imaging changes of emergency bedside ultrasonography showed the intra-aortic light band floating or double chamber changes,the inner diameter of the ascending aorta>42 mm,aortic valve regurgitation and pericardial effusion was found in 80 cases(82.47%),62 cases(63.92%),76 cases(78.35%)and 37 cases(38.14%)respectively in Stanford type A,and in 42 cases(84%),10 cases(2%),23 cases(46)and 5 cases(10%)respectively in Stanford type B.The sensitive rate(with one or more the sonographic changes mentioned above)was 96.91%in Stanford A and 84%in Stanford B.Conclusion Emergency bedside ultrasonography can play an important role for early and rapid diagnosis of AAD,which can be the preferred diagnostic technique.