无痛性主动脉夹层八例临床特点和误诊分析

Clinical Characteristics and Misdiagnosis of Painless Aortic Dissection in 8 Cases

目的分析无痛性主动脉夹层患者的临床特点和误诊原因,总结防范误诊措施。方法回顾性分析2016年3月—2022年2月曾被误诊的8例无痛性主动脉夹层的临床资料。结果本组首发症状表现为肢体乏力、晕厥、头痛、意识障碍、咳嗽、胸闷、气促等,根据病史、体格检查及常规辅助检查初始诊断为脑卒中4例,肺部感染1例,癫痫1例,急性冠状动脉综合征2例,误诊时间1 h~1周。按初诊疾病给予相应治疗均无效,进一步回顾病史、D-二聚体水平以及完善主动脉CT血管成像等检查确诊为主动脉夹层。确诊后分别予保守或急诊手术治疗,3例成功手术者随访1年生存良好,余病例死亡。结论对于无痛性主动脉夹层患者的诊断,应该掌握其常见临床表现及特点,培养良好的临床思维,仔细询问病史,认真查体,去伪存真,根据疾病特点及时完善相关辅助检查,尽早明确诊断,减少或避免误诊。

Objective To analyze the clinical characteristics and causes of misdiagnosis of painless aortic dissection,and to summarize preventive measures.Methods Clinical data of 8 patients with painless aortic dissection who were misdiagnosed from March 2016 to February 2022 were retrospectively analyzed.Results In this group,the initial symptoms were limb weakness,syncope,headache,disturbance of consciousness,cough,chest tightness,and shortness of breath.According to the medical history,physical examination and routine auxiliary examination,the initial diagnosis was stroke in 4 cases,pulmonary infection in 1 case,epilepsy in 1 case,and acute coronary syndrome in 2 cases.The duration of misdiagnosis was 1 h to 1 week.The corresponding treatment was ineffective according to the newly diagnosed disease.Further review of the history,and improved examinations of D-dimer and CT angiography of the aorta confirmed the diagnosis of aortic dissection.After diagnosis,the patients were treated with conservative or emergency surgery.Three patients survived well at 1-year follow-up,and the others died.Conclusion For the diagnosis of patients with painless aortic dissection,it is necessary to master the common clinical manifestations and characteristics,cultivate good clinical thinking,carefully inquire into the medical history,carefully perform physical examination,eliminate the false and retain the true,timely improve the relevant auxiliary examination according to the characteristics of the disease,and make a clear diagnosis as soon as possible,so as to reduce or avoid misdiagnosis.