急性主动脉夹层168例临床诊治分析

摘要

Objective To investigate the misdiagnosis, therapy and prognosis of acute aortic dissection (AAD). Methods Clinical data of 168 cases with AAD from January 2004 to June 2016 in Donghua Hospital affiliated to Sun Yat-sen University were retrospectively analyzed. Results The male to female ratio was 5.46: 1, ages were 20-91 (51.22 +14.44) years,with an average duration from onset for 4 h. All were diagnosed by aortic CT angiography(CTA). There were 87 cases (51.79%) of type I,20 cases(11.90%) of type II and 61 cases(36.31%) of type III according to the Debakey Classification. Chest (backache) pain was the common primary symptoms in 128 cases (76.19%). 61 cases (36.31%) were misdiagnosed initially,with a duration from onset for 1-24(10.5 ± 7.4) h. Acute myocardial infarction was the most common misdiagnosis,followed by chronic kidney disease. 50 cases stayed in hospital within 1 day, with 86 cases no more than 4 days. There was a higher in-hospital mortality rate for patients initially admitted to the other departments rather than the Department of Cardiology with a significant statistical difference (P0.05 ). Conclu-sion The incidence of AAD is increasing year by year,with misdiagnosis a severe problem. For patients by DeBakey III,en-dovascular repair is not superior to conservative treatment on short-term survival in hospital.%目的 探讨急性主动脉夹层(acute aortic dissection, AAD)的临床诊治及误诊、预后情况.方法 对2004年1月—2016年6月中山大学附属东华医院收治的AAD 168例的临床资料进行回顾性分析.结果 本组男女比5.46: 1,年龄20~91 (51.22 ± 14.44)岁,平均病程4 h,均经全主动脉螺旋CT动脉造影(CTA)检查确诊.De-Bakey分型I型87例(51.79%),II型20例(11.90%),III型61例(36.31%).以胸(背)痛为首发症状最常见,共128例(76.19%).门急诊首诊误诊率36.31%(61/168),误诊时间1~24(10.5 ± 7.4)h,误诊最多的疾病是急性心肌梗死,其次是慢性肾脏病.50例住院1 d,86例住院≤4 d.院内病死率首诊收住非心血管内科患者高于首诊收住心血管内科患者,差异具有统计学意义(P0.05).结论 现AAD发病有逐年增多趋势,且临床首诊误诊情况严重.DeBakey III型AAD患者在院内病死率方面主动脉腔内隔绝术并不优于保守治疗.