主动脉夹层39例临床分析

摘要

目的：探讨主动脉夹层(AD)的临床特征、诊断和治疗方法，以提高AD的诊治水平。方法回顾性分析笔者所在两家三级医院2008年1月至2012年12月收治的39例AD患者的临床资料。结果(1) DeBakey分型：Ⅰ型12例(30.8%)，Ⅱ型6例(15.4%)，Ⅲ型21例(53.8%)；(2)疼痛是AD的主要临床表现，共34例(87.2%)；(3)误诊11例，误诊率为28.2%；(4)诊断符合率：超声心动图76.9%，CT血管造影100%，磁共振成像100%。结论主动脉夹层主要症状为持续剧烈胸腹背疼痛，早期诊断是治疗关键，UCG、CTA及MRI有助于确诊，在有效内科治疗基础上及时手术或介入治疗是降低死亡率的有效方法。%Objective To investigate the clinical characteristics, diagnosis and treatment methods of aortic dissection (AD) and to improve diagnosis and treatment of AD. Methods Clinical data of 39 patients with AD in our hospitals from January 2008 to December 2012 were analyzed retrospectively. Results (1) Classification DeBakey:typeⅠwere 12 cases (30.8%), typeⅡwere 6 cases (15.4%) and typeⅢwere 21 cases (53.8%). (2) The pain was the main clinical manifestation of AD, which occounted in 34 cases (87.2%). (3) The misdiagnosis rate was 28.2%. (4) The accurate rate of diagnosis:UCG was 76.9%, CTA was 100%and MRI was 100%. Conclusion Pain on chest, ab-dominal or back is an original manifestation of AD. Early diagnosis is the key to success treatment. UCG, CTA and MRI contribute to diagnosis. Promptly surgery or interventional therapy with medical therapy is an effective method to reduce mortality.