夜间急诊超声在主动脉夹层早期诊断的应用效果研究

目的 探讨夜间急诊超声在主动脉夹层早期诊断的应用效果,为临床提供参考。方法 回顾性分析2018年6月至2022年6月曹县人民医院收治的74例疑似主动脉夹层（AD）患者的临床资料,均行床旁超声检查,以主动脉CT造影结果为金标准,分析床旁超声检查对不同AD分型检出率、各临床征象检出率及诊断效能。结果 床旁超声检查在ADⅠ型、Ⅱ型、Ⅲ型检出率与主动脉CT造影比较,差异无统计学意义（P>0.05）;两种方法在心包积液、假腔血栓、AD破裂口、主动脉瓣关闭不全、左室壁运动异常等各临床征象检出率比较,差异无统计学意义（P>0.05）;主动脉CT造影显示,阳性51例,阴性23例;床旁超声检查中,阳性48例,阴性26例;床旁超声检查诊断AD的敏感度为88.24%,特异度为86.96%,准确度为87.84%,阳性预测值为93.75%,阴性预测值为76.92%。结论 夜间急诊超声应用于AD的早期诊断效果显著,诊断方便、快捷,且具有较好的敏感度、特异度及准确度,可作为首诊工具。     

床旁彩色多普勒超声在经皮肾镜碎石取石术后肾假性动脉瘤出血中的诊断价值

目的探讨床旁彩色多普勒超声对经皮肾镜碎石取石术（PCNL）术后并发肾假性动脉瘤出血的临床应用价值。方法对2017年11月~2019年11月在南方医院采用介入栓塞治疗的9例PCNL术后并发肾出血患者的行床旁彩色多普勒超声检查、临床资料、数字减影血管造影检查及治疗效果进行回顾性分析。结果9例行肾动脉栓塞术治愈的患者（造影结果详细列出:单纯动脉损伤5例,假性动脉瘤4例,动静脉瘘0例）,动脉栓塞前均行床边彩超检查,其中床旁彩超诊断出4例肾假性动脉瘤,最终经肾动脉造影确诊。结论床旁彩色多普勒超声,对PCNL术后继发肾假性动脉瘤的诊断有较大的优越性和临床价值。      

主动脉夹层误诊为急性心肌梗死临床特征并文献分析

目的 探讨误诊为急性心肌梗死(AMI)的主动脉夹层(AD)的临床特点、鉴别诊断要点及误诊原因、防范措施。方法 回顾性分析误诊为AMI的AD 8例的临床资料,并结合国内外文献进行分析。结果 本组8例均为男性,有高血压病史6例,皆以胸痛为主要症状,D-二聚体明显升高,心电图有明显ST-T改变。5例误诊为急性ST段抬高型心肌梗死,3例误诊为急性非ST段抬高型心肌梗死。误诊时间平均11 h。8例经AMI相关治疗后效果均欠佳,皆经主动脉CT血管造影检查确诊为AD,给予相应治疗。经治疗后好转3例,死亡5例。结论 AD以急性胸痛为主要症状并伴心电图ST-T改变时,易误诊为AMI。临床医生应提高警惕,注意上述2种疾病的鉴别诊断要点,详细问诊及仔细查体,并尽早采取有效影像学检查,以减少或避免AD误诊误治。     

床旁超声心动图在Stanford A型主动脉夹层诊断和院内死亡风险评估中的价值

目的 探讨床旁超声心动图(UCG)在Stanford A型主动脉夹层(AD)诊断和院内死亡风险评估中的价值。方法 回顾性选取2019年6月至2023年6月大同市第五人民医院收治的AD患者104例为研究对象,均给予床旁UCG与数字减影血管造影(DSA)检查,分析床旁UCG临床诊断Stanford A型AD的价值;根据院内存活与死亡情况将确诊为Stanford A型AD的患者分为存活组(n=52)和死亡组(n=28)。绘制受试者工作特征(ROC)曲线,评估床旁UCG的临床诊断价值。分析两组人口学资料、既往病史、疾病信息,并观察两组床旁UCG的图像表现。多因素Logistic回归分析Stanford A型AD患者院内死亡的影响因素。结果 经DSA检查,Stanford A型AD患者80例,StanfordB型AD患者24例。床旁UCG诊断Stanford A型AD患者为79例,Stanford B型AD患者为25例。床旁UCG诊断Stanford A型AD患者的敏感性为97.50%,特异性为95.83%,准确性为97.12%,曲线下面积为0.961,95%CI(0.000～1.000)(P&...     

不典型主动脉夹层4例误诊分析

目的:探讨不典型主动脉夹层(AD)的临床特点,以提高其诊断的准确率.方法:回顾性分析误诊的不典型AD 4例的临床资料.结果:4例患者均无明显胸痛,以胸闷为主诉3例,晕厥后停止排气、排便1例,分别被误诊为胸腔积液、肠梗阻、冠心病和高血压.4例X线均未见纵隔增宽,心脏彩超(UCG)示腹部动脉夹层2例,主动脉增宽1例,未见异常1例,后2例经CT血管成像(CTA)和(或)主动脉造影确诊.4例患者均确诊为De Bakey Ⅲ型AD.结论:De Bakey Ⅲ型AD临床表现不典型,需详细询问病史及体检,胸片和心脏彩超无阳性表现时,有必要行CTA等检查.     

CT血管成像在急诊胸主动脉夹层中的应用

目的：探讨多层螺旋CT血管成像（CT angiography, CTA）在急诊胸主动脉夹层（thoracic aortic dissection, TAD）中的应用价值。方法回顾分析42例手术确诊为TAD患者的影像学资料,其中22例患者经CTA检查,18例经超声多普勒检查,27例经数字减影血管造影（digital subtract angiography, DSA）检查,研究3种检查方法在TAD患者诊断中的正确诊断率及耗时。结果22例患者经CTA检查全部诊断为主动脉夹层,正确诊断率为100%,DeBakey分型准确,平均耗时为25 min;27例患者经DSA检查全部诊断为主动脉夹层,正确诊断率为100%,DeBakeyⅠ型误诊为Ⅱ型者1例,平均耗时38 min;经胸超声检查有11例诊断为主动脉夹层,正确诊断率为61.1%,经食道超声检查有16例诊断为主动脉夹层,正确诊断率为88.9%,两者结合可全部确诊18例患者为主动脉夹层,正确诊断率为100%,DeBakey分型准确,平均耗时24 min。结论CTA具有诊断正确率高、分型准确、耗时少等特点,是TAD急诊诊断方法的理想选择。     

彩色多普勒超声诊断内脏动脉瘤的临床价值

目的 探讨彩色多普勒超声(彩超)诊断内脏动脉瘤的临床价值.方法 应用彩超对腹痛及高血压患者进行内脏动脉筛查,彩超检出动脉瘤者行CT血管造影(CTA)、数字减影血管造影(DSA)检查进一步证实诊断.结果 本组彩超检出内脏动脉瘤15例,其中脾动脉瘤6例,腹腔干动脉瘤4例,肠系膜上动脉瘤3例,肾动脉瘤2例.彩超声像图特征为内脏动脉走行上出现瘤样结构,瘤体内为红蓝交替的漩涡状动脉血流信号,部分瘤体合并血栓、瘤壁钙化及瘤后狭窄.15例均经CTA检查证实诊断,3例经DSA检查再次证实诊断.结论 彩超能够准确反映瘤体部位、大小和血流动力学特征,对内脏动脉瘤有较高的诊断价值.     

急诊床旁超声在急性主动脉夹层诊断中的价值

目的:探讨急诊床旁超声在急性主动脉夹层诊断中的价值。方法:回顾分析我院收治的33例急性主动脉夹层的病例资料,将急诊床旁超声与主动脉CT造影的结果进行对照分析。结果:急诊床旁超声检出主动脉夹层28例,检出率为84.8%。其中急诊床旁超声对DebakeyⅠ型主动脉夹层的检出率为94.1%,对DebakeyⅡ型主动脉夹层的检出率为90.9%,对DebakeyⅢ型主动脉夹层的检出率为40%。结论:急诊床旁超声检查具有快速、无创、安全、重复性好、准确性高等优势,是急性主动脉夹层患者首选的检查方法。     

主动脉夹层二例临床分析

目的分析主动脉夹层(aortic dissection,AD)的临床特点,以提高本病诊断率。方法对2例以偏瘫为首发症状AD的临床资料进行回顾性分析。结果本文2例分别以左侧肢体或右下肢无力就诊,例1初诊为脑血管意外,渐出现腹泻血样黏液便,经完善相关检查确诊为AD;例2入院后第2天经MRI检查确诊,虽经积极救治,但终因病重死亡。结论 AD临床表现不典型,对以高血压、偏瘫或其他精神症就诊者,应警惕AD可能,尽早行彩超、CT或MRI检查,以便早期确诊,挽救患者的生命。     

急性主动脉夹层患者的围手术期护理

我院对Standford B型急性主动脉夹层患经术前合理药物治疗控制病情后，采用了腔内支架隔绝术方法进行及时有效的治疗17例，护理体会如下。 1 临床资料 1．1 一般资料 男11例，女6例，年龄38～79（平均57）岁。经螺旋CT、心脏彩超检查均确诊为急性主动脉夹层。本组均有不同程度的高血压病，伴有胸背部剧烈疼痛15例,心前区疼痛2例。     

Emergency Bedside Ultrasound Diagnosis of Superior Mesenteric Artery Dissection Complicating Acute Aortic Dissection

Background

A timely diagnosis of aortic dissection is associated with lower mortality. The use of emergent bedside ultrasound has been described to diagnose aortic dissection. However, there is limited literature regarding the use of bedside ultrasound to identify superior mesenteric artery dissection, a known high-risk feature of aortic dissection.

Objective

Our aim was to present a case of superior mesenteric artery dissection identified by bedside ultrasound and review the utility of bedside ultrasound in the diagnosis of aortic emergencies.

Case Report

We report a case of superior mesenteric artery dissection found on emergent bedside ultrasound in a 46-year-old male complaining of abdominal pain with a history of cocaine abuse and prior aortic dissection. Bedside ultrasound in the emergency department revealed an intimal flap in the descending aorta with extension into the superior mesenteric artery prompting early surgical consultation before computed tomography because of concern for acute mesenteric ischemia.

Conclusion

Superior mesenteric artery dissection is a high-risk feature of aortic dissection and can be identified with emergent bedside ultrasound.     

D-Dimers in the Emergency Department Evaluation of Aortic Dissection

Aortic dissection (AD) is the most common acute aortic condition requiring urgent surgery. AD, if not diagnosed in the emergency department (ED), is frequently fatal. AD is a difficult antemortem diagnosis. OBJECTIVES: To determine if acute AD is associated with an elevation of fibrin degradation products, D-dimers. METHODS: This was a retrospective chart review of patients diagnosed as having AD in the ED in whom a D-dimer determination was obtained in the ED, prior to any therapeutic intervention. The study was conducted in an urban Level I trauma center between October 1996 and September 2000. Exclusion criteria were referred patients with known diagnosis of AD. The D-dimer assay used was the semiquantitative latex agglutination assay, with a normal range up to 0.5 micro g/mL. RESULTS: One hundred fifty-six patients were diagnosed as having AD in the ED. Seven patients had a D-dimer assay during their workup. All seven had a positive test. CONCLUSIONS: All seven patients with an AD who had D-dimer assays performed in the ED had positive results by latex agglutination.     

超声心动图诊断急性主动脉壁内血肿

目的 探讨超声心动图诊断急性主动脉壁内血肿(AIH)的临床价值。方法 回顾性分析以胸背部突发性疼痛急诊入院、经手术和(或)CTA诊断为AIH的20例患者的超声心动图表现,并与CTA或手术结果进行对比。结果 20例中,10例超声诊断为AIH,4例诊断为主动脉夹层(AD)并假腔内血栓形成,5例诊断为AD,1例诊断为阴性。超声心动图显示受累的主动脉管壁不同程度增厚,厚度 5~20 mm,断面呈环形或新月形,未探及明显的内膜回声中断;CDFI示病变管腔与血肿间无明显血流交通。结论 超声心动图是急诊筛查AIH的有效方法,可及时为临床提供准确信息,指导治疗。     

高频超声及彩色多普勒对乳腺癌的诊断价值

目的评价高频超声及彩色多普勒对乳腺癌的诊断价值。方法应用高频二维超声对148例乳腺肿块患者进行检查,观察肿块的部位、大小、形态、边界、纵横比、内部回声、后方回声、有无微小钙化及腋下淋巴结肿大等;结合彩色多普勒血流显像观察乳腺肿块的特征。结果148例乳腺癌均经手术和病理证实,超声诊断提示恶性肿瘤133例,诊断符合率为90%(133/148)。结论高频二维超声结合彩色多普勒血流显像对乳腺癌具有较高的诊断价值。     

彩色多普勒超声对乳腺肿块的鉴别诊断分析

目的 探讨彩色多普勒对乳腺肿块的诊断价值。方法 回顾性分析146例经手术病理证实的乳腺肿块的临床资料,比较术前二维及彩色多普勒超声诊断与术后病理诊断的差异。结果 二维及彩色多普勒超声诊断为乳腺癌82例中,术后病理证实75例,符合率为91．5％;超声诊断为乳腺良性肿块64例患者术后病理证实60例,符合率为93．8％;本组典型乳腺癌声像图表现为形态不规则、边界不清、内部回声不均、砂粒样钙化、后方回声衰减,CDFI示血流信号较丰富。结论 超声对乳腺肿块有较高的诊断价值,但仍有局限性。     

主动脉夹层急诊救治与临床路径探讨

目的 探讨主动脉夹层(aortic dissection,AD)的临床特点与急诊救治方法及路径.方法 采用回顾性分析方法,收集2000年1月至2009年12月中南大学湘雅医院急诊科收治的784例主动脉夹层患者的临床资料等分别进行对比及统计分析,分析其存活率、病死率及有效率.结果 首发症状以痛疼为主占77.7%(609/784),原有高血压病史占86.5%(678/784).确诊至术前784例均行急诊内科救治,存活率81.5%(639/784),病死率18.5%(145/784),无效157例(20.0%),总有效率(83.1%),其中传统治疗有效率(76.4%),三联四程序化治疗有效率(89.8%)(P<0.05),差异具有统计学意义.在院急诊死亡139例(17.7%).其中24 h内死亡26例(18.4%),48 h内死亡47例(33.8%),72 h死亡66例(47.2%).确诊后拒绝治疗92例,其中72 h内死亡81例(88.04%),两组病死率相比较,具有统计学意义(P<0.05).结论 详细病史、体查及CT和MRI主动脉造影检查是诊断主动脉夹层的主要手段,镇痛、镇静、降压是急诊救治的重要方法.急诊早期确诊和有效救治为争取早期手术及进一步治疗赢得了时间,是提高AD生存率的关键.

Abstract：

Objective To investigate the clinical features of aortic dissection (AD) and emergency treatments. Methods Data from 784 patients with aortic dissection were collected in the Department of Emergency from January 2000 through December 2009. A retrospective analysis was carried out to determine the survival rate, mortality rate and treatment efficiency. Results Pain was the most common onset symptom (77.7% , 609/784). The majority of patients (86.5%) had essential hypertension (678/784). All the patients with preoperative diagnosis of aortic dissection underwent emergency medical intervention by internists resulting in 81.5% survival rate (639/784) and 18.5% mortality rate (145/784). There were 157 patients without improvement (20.0% ) and the total efficiency rate was (83. 1% ). The efficiency rate of conventional treatment was 76.4% , while the efficiency rate of triple four-procedure treatment was 89. 8% (P<0.05). Of them, 139 patients (17. 7% ) died in the hospital. Among them,. 26 patients died within 24 hours (18.4% ) and 47 cases died within 48 hours (33. 8% ) and 66 patients died within 72 hours (47.2% ). There were 92 patients who refused treatments after diagnosis, and among them, 81 patients died within 72 hours (88.04% ). The difference in mortality rate between two groups was significant (P<0.05). Conclusions The diagnosis of aortic dissection depends on detailed history, physical examination and CT or MRI imaging. Analgesia, sedation and control of blood pressure are essential for emergency treatments. Early diagnosis and effective emergency treatments are the critical strategy for the early surgical intervention and time window for further treatment to improve the survival rate of AD.     

主动脉夹层急诊诊治体会(附11例临床分析)

目的:分析主动脉夹层(AD)的临床特征及诱因,提高急诊确诊率。方法:回顾性分析我院2010年1月-2010年6月AD患者的临床资料。结果:11例AD患者中10例首发症状为疼痛,疼痛部位以胸、腹部为主,并发高血压病史者较多;误诊疾病复杂多样,以急腹症居多,首诊误诊率54.5%;治疗上以内科保守治疗为主。结论:AD首发症状主要为剧烈胸腹疼痛,病死率高,早期及时确诊,降低血压、心率可显著降低病死率。     

彩色多普勒超声在主动脉夹层诊断中的应用

评价彩色多普勒超声对主动脉夹层的应用价值。方法对１５例临床误诊为急性心肌梗塞（６例）及急性胰腺炎（６例）、纵隔肿瘤（１例）、肾结石（１例）、胃肠炎（１例）应用ＣＤＵＳ作纵横切面连续扫查。结果：１５例ＣＤＵＳ均显示为ＡＤ声像图特征。并分别经ＣＴ、手术、尸解证实。结论ＣＤＵＳ能正确诊断ＡＤ及其并发症。     

Type A aortic dissection developed after type B dissection with the presentation of shoulder pain: A case report

BACKGROUNDAortic dissection (AD) is a life-threatening condition with a high mortality rate without immediate medical attention. Early diagnosis and appropriate treatment are critical in treating patients with AD. In the emergency department, patients with AD commonly present with classic symptoms of unanticipated severe chest or back pain. However, it is worth noting that atypical symptoms of AD are easily misdiagnosed.CASE SUMMARYA 51-year-old woman was first diagnosed with scapulohumeral periarthritis due to left shoulder pain. After careful examination of her previous medical history and contrast-enhanced computed tomography angiography, the patient was diagnosed with a new type A AD after chronic type B dissection in the ascending aorta. The patient was successfully treated with surgical replacement of the dissected aortic arch and remains in good health.CONCLUSIONNew retrograde type A AD after chronic type B dissection is relatively rare. It is worth noting that a physician who has a patient with suspected AD should be vigilant. Both patient medical history and imaging tests are crucial for a more precise diagnosis.