主动脉夹层急诊诊断与误诊分析

Study on the diagnosis and misdiagnosis of aortic dissection

目的 探讨主动脉夹层的临床表现 ,急诊诊断及误诊情况。方法 分析 5 3例主动脉夹层临床表现、体格检查、实验室检查及心电图、X线片、CT、B超等辅助检查结果 ,分析急诊诊断的依据及急诊误诊情况。结果 5 3例主动脉夹层临床表现各异 ,部份病例以并发症为首发症状 ,如瘤体破裂造成的急性心脏压塞征、出血性休克 ,亦有主动脉分枝急性闭塞造成器官缺血坏死或压迫所致的单瘫、截瘫、急性左心衰、气胸、中等量以上心包积液 ,是造成本组误诊的主要原因。主动脉夹层系一少见疾病 ,临床医师缺乏对本病的认识也是原因之一。初诊误诊率 2 8%。结论 主动脉夹层临床表现复杂 ,易误诊 。

Objective To study the symptoms and physical signs,diagnosis and misdiagnosis of aortic dissection in emergency department.Methods The symptoms,physical signs,and the results of laboratory test,electrical cardiac gram,X_ray pictures were analyzed.CT,B type ultrosound of 53 patients with aortic dissection were analyzed the diagnosis and misdiagnosis in emergency department.Results The symptoms and physical signs of aortic dissection were different in 53 patients.The symptoms for misdiagnosis were:(1)some patients had such initial symptoms as cardiac tamponade,hemorrhagic shock,monoplegia,paraplegia,acute left heart failure,pneumatothorax,hydrocardia;(2)some doctors knew little about aortic dissection because the disease happened rarely.The misdiagnosis rate was 28%.Conclusion The symptoms and physical signs of aortic dissection are different The disease is easy to be misdiagnosied,and it should be known well by emergency doctors. [