主动脉夹层33例误诊漏诊原因分析

目的：进一步提高对主动脉夹层（AD）的认识,减少误诊和漏诊。方法：对我院急诊内科、心内科、胸外科33例曾经误诊为其它疾病的主动脉夹层患者的临床资料进行回顾性分析。结果：33例中被螺旋CT证实16例（48．5％）,磁共振证实10例（30．3％）,彩色多普勒证实10例（30．3％）,l例（3％）来不及检查,尸检证实。AD的临床特点：（1）50岁以上17例（81．8％）;（2）伴高血压病24例（72．7％）,动脉硬化25例（75．8％）;（3）剧烈疼痛：都有剧烈疼痛,其中：胸腹痛29例（87．9％）,腰痛8例（24．2％）;（4）血压脉搏两侧不对称10例（30．3％）,总误诊漏诊33例（100％）,误诊时间（36．0±41．6）h,误诊疾病：心血管病10例（30．3％）,消化系统疾病12例（36．4％）,呼吸系统疾病8例（24．2％）。结论：熟悉主动脉夹层的临床特点,及时采用影像学检查方法,进行综合分析,可避免误诊和漏诊。

Analysis of causes of diagnostic errors and missed diagnosis in 33 patients with aortic dissection

Objective： To further improve the recognition for aortic dissection （AD） and decrease diagnostic errors and missed diagnosis. Methods： Clinical data of 33 AD patients, who had been misdiagnosed as other diseases from department of emergency, cardiology and thoracic surgery, were retrospectively analyzed. Results： Among the 33 cases, 16 cases （48. 5%） were proved by spiral CT, 10 cases （30.3%） were proved by MRI, 10 cases （30.3%） were proved by color Doppler ultrasound, and one case （3%） was proved by autopsy because received measure too late. Clinical received measure too late features of AD were： （1） there were 17 cases （81.8%） over 50 years old; （2） 24 cases （72.7%） were complicated with hypertension and 25 cases （75. 8%） were complicated with arteriosclerosis; （3） intensive pain： all patients had intensive pain, including 29 cases （87. 9%） with chest and abdominal pain, eight cases （24.2%） with lumbago; （4） there were 10 cases （30.3%） with blood pressure and pulse asymmetry of two sides. Diagnostic errors and missed diagnosis： the total diagnostic error and missed diagnosis rate was 100% for 33 cases, misdiagnosis time was （36. 0 ± 41.6） h, and misdiagnosis diseases were 10 cases （30.3%） of cardiovascular diseases, 12 cases （36. 4%） of digestive system diseases and eight cases （24. 2%） of respiratory diseases. Conclusion.. Diagnostic errors and missed diagnosis can be avoided through being familiar with clinical features of aortic dissection and comprehensive analysis using iconographic measurement promptly.