【摘要】 目的探讨主动脉夹层(aorticdissection,AD)的临床特点、早期诊治方法。方法分析与总结我院主动脉夹层33例临床资料。结果男∶女比为5.6∶1,平均年龄60岁;高血压病占81·8%;突发剧烈疼痛26例(78·8%),前胸部疼痛22例。22/26例超声诊断为AD,20例MRI诊断为AD,11例CT诊断为AD。13例患者心电图有异常表现,ST-T改变10例,12例左室肥大或高电压。高血压患者首选静脉滴注或微泵静注硝酸甘油或硝普钠,联合应用β受体阻滞剂、钙拮抗剂、血管紧张素转换酶抑制剂,将收缩压控制于100~120mmHg,心率60~70次/分。27例患者血压控制后疼痛逐渐减轻或消失,病情趋于稳定,2例行急诊主动脉置换术,6例1周~1个月内因破裂死亡。结论AD的临床表现复杂,误漏诊率高,UCG/MRI/CT检查对提高其早期诊断及指导治疗有重要意义。急性期以内科治疗为主,主动脉置换手术是治疗AD的有效手段。更多还原

【Abstract】 Objective Discussing the clinical features, early diagnosis and therapeutic methods of aortic dissection (AD). Methods We analyzed and concluded the clinical datum of 33 AD patients in our hospital. Results The rate of male to female was 5.6 to 1 among all patients, average age 60, hypertension accounted for 81.8 percent. There were 26 patients (78.8 percent) suffered an acute pain, of who 22 patients got a pain in anterior chest.There were 22 of 26 patients diagnosed AD through echocardiography, 20 and 11 patients confirmed AD by MRI or CT respectively among all 33 patients. 13 patients had abnormal ECG, 10 ST-T segment changed, 12 left ventricular hypertrophy or hyper-voltage. Hypertension patients were treated through a infusion of nitroglycerin or nitroprusside by intervenous drop or by vein pump firstly to decend systolic blood pressure to the level of 100~120 mmHg and heart rate to 60~70 bpm,combining with the use of beta blocker, calcium antagonist and rennin- angiotensin inhibitor. 27 patients’ pain alleviated gradually even disappeared after controling their blood pressure, whose state of illness became to stable. 2 persons did the operation of aortic replacement in emergency. 6 persons died for aortic dissection broken in one week or one month. Conclusions The clinical manifestations of AD are complex, and the rate of false or leak diagnosis is high. Radiology studies including echocardiography, MRI or CT may be very important to enhance the ability of diagnosing AD early and to guide the treatment. Taking medical treatment is primary in emergency. Operating the replacement of aorta is an effective measure to treat AD.更多还原