D-二聚体在急性血管性疾病鉴别诊断中的应用——附三例病例分析

Application of D-dimer in the differential diagnosis of acute vascular diseases in three cases

目的 探讨D-二聚体在急性血管性疾病,尤其是3A[急性主动脉夹层(acute aortic dissection,AAD)、急性肺栓塞(acute pulmonary embolism,APE)、急性心肌梗死(acute myocardinal infarction,AMI)]急症鉴别诊断中的临床应用。方法 结合急性血管性疾病患者临床症状体征,对3例以不典型胸背疼痛为主要表现的病例进行分析,快速检测D-二聚体,筛查胸背部疼痛病因,总结分析D-二聚体在急性血管性疾病尤其是3A急症鉴别诊断中的实用性。结果 3例以不典型胸背部疼痛就诊的病例,结合病史、症状体征,快速检测D-二聚体及据其检测结果引导进一步影像学病因筛查,分别确诊为AAD、APE、AMI,患者得到了及时诊断和治疗。结论 D-二聚体检测结果有助于引导急性血管性疾病尤其是3A急症的鉴别诊断方向,帮助医师做出快速临床诊断,并形成系统化的思维模式。

Objective To explore the application of D-dimer in the differential diagnosis of acute vascular disease,especially 3A(acute aortic dissection[AAD],acute pulmonary embolism[APE],acute myocardial infarction[AMI]).Methods Combined with the clinical symptoms and signs of patients with acute vascular diseases,three cases with atypical chest and back pain were analyzed.D-dimer level was quickly detected,and the causes of chest and back pain were screened.Moreover,the practicability of D-dimer in the differential diagnosis of acute vascular diseases,especially 3A emergency was summarized and analyzed.Results Three cases of atypical chest and back pain were diagnosed with acute aortic dissection,acute pulmonary embolism and acute myocardial infarction by rapid detection of D-dimer based on medical history,symptoms and signs,and laboratory testing and imaging examinations for screening causes.Patients were diagnosed and treated in time.Conclusion The detection results of D-dimer are helpful to guide the direction of differential diagnosis of acute vascular diseases,especially 3A emergency,helping doctors make a rapid clinical diagnosis,and forming a systematic thinking mode.