主动脉夹层11例临床分析

摘要

目的 探讨主动脉夹层(aortic dissection,AD)的临床特点、早期诊断及治疗对策.方法 对11例AD的临床资料进行回顾性分析.结果 本组表现为突发胸背部剧烈撕裂样疼痛8例,剑突下疼痛、恶心、呕吐2例,腰腹部疼痛、呕吐、恶心1例.病初确诊为主动脉夹层6例,误诊为急性心肌梗死、急性胃肠炎各2例,肾绞痛并肾功能不全1例.误诊病例后经彩色多普勒超声及增强螺旋CT扫描确诊4例,尸体解剖确诊1例.治疗后好转5例,住院时间最短7 d,最长35 d;死亡6例.结论 AD临床表现多样,易误诊、漏诊,及时诊断并合理治疗是改善预后的关键.%Objective To investigate clinical features, early diagnosis and therapy of aortic dissection (AD).Methods The clinical data of 11 patients with AD was retrospectively analyzed. Results There were many clinical manifestations, such as sudden severe tearing pain on chest and back ( 8 cases), under the xiphoid pain, nausea and vomiting (2 cases), waist and abdomen pain, vomiting and nausea (1 case). 6 cases were diagnosed as aortic dissection, but 2 cases were misdiagnosed as acute myocardial infarction, 2 cases as acute gastroenteritis and 1 case as renal colic and renal insufficiency. The misdiagnosed cases were diagnosed by color Doppler ultrasound and post-enhanced spiral CT scan in 4 cases, autopsy in 1 case. After treatment 5 cases improved, the shortest length of stay was from 7 d up to 35 d; 6 patients died. Conclusion AD is liable to be misdiagnosed because of its diverse clinical manifestations, and timely diagnosis and rational treatment are important in improving the prognosis.