主动脉夹层37例临床分析

目的：探讨主动脉夹层（AD）的临床特征、早期诊断及治疗。方法：回顾性分析我院2008年1月至2012年9月收治的主动脉夹层患者37例的临床资料。结果：本组37例中,有高血压病史27例（73．0％）,大多血压控制不良。突发起病占73．0％,主要表现为疼痛（91．4％）,胸背痛居多,腹痛、腰痛其次,少数表现有晕厥、气急。疼痛呈撕裂样痛、剧烈闷痛、锐痛;人院时血压升高者占62．8％,1例双上肢血压相差较大,3例主动脉瓣区闻及舒张期杂音;全部病例行主动脉cT造影加三维重建证实,按DeBaKey分型：I型5例,Ⅲ型32例。本院首诊12例,首诊误诊5例（41．7％）。结论：AD的临床症状变化较多,易误诊、漏诊,提高对该病的认识,方能做到早期诊断及治疗。     

Acute Aortic Regurgitation with Myocardial Infarction: An Important Clue for Aortic Dissection

Background

Aortic dissection is an important cause of acute chest pain that should be rapidly diagnosed, as mortality increases with each hour this condition is left untreated. The diagnosis can be challenging, especially if concomitant myocardial infarction is present. Echocardiography is an important tool for the differential diagnosis.

Objectives

To stress the importance of recognizing aortic regurgitation for the differentiation of myocardial infarction and aortic dissection.

Case Report

An 80-year-old woman was admitted to our hospital with chest pain that was diagnosed as inferior and lateral wall myocardial infarction based on electrocardiographic findings. The diagnosis was reevaluated when aortic regurgitation was detected on echocardiography. Closer inspection of the ascending aorta revealed a dissection flap as the cause of aortic regurgitation.

Conclusion

Detection of aortic regurgitation in a patient with myocardial infarction and normal valves should prompt the search for a possible aortic dissection, whether or not the dissection flap can be visualized.     

Acute Aortic Dissection: Pathophysiology and Antihypertensive Therapy

The therapeutic objectives of antihypertensive drugs for acute aortic dissection (AAD) are decreasing systolic blood pressure and reducing rate of left ventricular ejection (dP/dt). Decreasing blood pressure and the shearing forces of myocardial contractility decreases intimal tear and propagation of dissection. Given the complexity of AAD, initiating the appropriate medication to achieve the optimal hemodynamic control can challenge nurse practitioners (NPs). Understanding the pathophysiology of AAD will help NPs in selecting the most appropriate antihypertensives to improve patient outcomes. This article presents an updated review of the antihypertensive drugs used in AAD based on best practice guidelines.     

D-二聚体在主动脉夹层中的临床意义

目的:通过检测不同类型、病期和预后主动脉夹层(AD)患者血中D-二聚体浓度,探讨D-二聚体对AD的临床意义。方法:回顾性分析45例AD患者的临床资料。结果:主动脉夹层形成后D-二聚体均升高,均值为866.1±430ug/L。D-二聚体水平在急性期显著高于慢性期(P<0.01),DⅠ型明显高于DⅢ型(P<0.01)。死亡患者D-二聚体水平显著高于存活者。结论:D-二聚体水平有助于不同病期、不同类型AD的诊断,对鉴别诊断、判断病变范围及预后有一定指导意义。     

术中经食道超声心动图在急性Stanford A型主动脉夹层手术中的应用价值

目的 探讨术中经食道超声心动图（Transesophageal Echocardiography,TEE）在急性Stanford A型主动脉夹层（AAD）手术中的应用价值。 方法 选取经全主动脉CTA诊断为ADD的患者41例,术前行TEE检查,根据TEE检出主动脉根部受累情况分为三组：夹层未累及主动脉根部组（A组）16例,主动脉根部轻-中度受累组（B组）9例,主动脉根部重度受累组（C组）16例。均行术前TEE检查观察主动脉根部形态、夹层受累情况,包括主动脉瓣叶形态、功能,测量并比较各组主动脉瓣环内径、主动脉窦部内径、窦管交界内径及可显示升主动脉段的最大内径,观察冠状动脉起始段形态;术后TEE即刻观察手术效果。并将TEE结果与术中所见进行比较。结果 41例患者术前TEE对升主动脉内撕裂的内膜片显示阳性率为100%。B、C组主动脉窦部内径均大于A组,C组主动脉窦部内径大于B组,差异均有统计学意义（P＜0.05）;A、B、C三组患者主动脉瓣环及升主动脉内径比较差异均无统计学意义。经手术证实,术前TEE诊断夹层累及冠状动脉的特异性为62.5%,敏感性为56%。术后TEE可评估人工主动脉瓣或修复主动脉瓣形态、功能,以及人工血管、冠状动脉等吻合情况。结论 术前TEE能准确评估AAD主动脉根部及冠状动脉受累情况,术后TEE可即刻评估手术效果,具有重要的临床应用价值。     

Emergency Cesarean Section Due to Acute Aortic Dissection Type A (Debakey I) without Marfan Syndrome: A Case Report and Review of the Literature

Background

Acute aortic dissection during pregnancy is an uncommon but important emergency due to its lethal risk to both mother and child. The dissection usually involves the ascending aorta or the aortic arch. Although additional affection of the descending aorta up to bifurcation is possible, further increasing the risk of organ malperfusion, full-length aortic dissection (DeBakey I) is known to be very rare. Dissection during pregnancy has been reported predominantly in combination with Marfan syndrome. Acute aortic dissection Stanford type A (AADA) DeBakey I during pregnancy without signs of Marfan syndrome as a warning signal is very uncommon in the current literature.

Objectives

The etiology, diagnosis, differential diagnosis, and management of this rare disease are discussed in relation to the current literature.

Case Report

We report the case of an athletic 34-year-old woman in the third trimester of pregnancy, without history of previous diseases, who presented to our Emergency Department after collapsing. In the resuscitation department, an emergency cesarean section was performed due to the start of circulation failure in the mother. Computed tomography scan revealed a severe aortic dissection starting from 1 cm distal the aortic valve over the full length up to the iliac arteries, involving the brachiocephalic and carotid arteries up to the level of the larynx. Emergency replacement of the ascending aorta and the aortic arch was performed. Both the mother and baby survived and were doing well 1 year postoperatively.

Conclusion

This alarming result of AADA (DeBakey I) in late pregnancy without obvious warnings such as Marfan syndrome illustrates the importance of performing early imaging in similar cases.     

急性主动脉夹层时间分布规律

目的 研究急性主动脉夹层时间分布规律.方法 回顾性研究我院2000年1月-2010年12月所有急性主动脉夹层患者的时间资料,分析其月份、季节、周以及时刻分布特点.结果 急性主动脉夹层月份分布高峰点为1月4日,高峰段为9月21日～次年4月19日(P＜0.05);季节分布以冬春季较多(P＜0.05);周分布无高峰点及高峰段...     

Chronic Aortic Dissection in a Young Adult

Background: Acute aortic dissection is a life-threatening disease that is often a diagnostic challenge in the Emergency Department (ED). Patients with acute aortic dissection often have underlying hypertension and atherosclerotic disease, and commonly present with acute-onset severe chest or back pain in their sixth or seventh decades of life. Aortic dissection, however, can also be seen in patients < 40 years old and may present chronically, with symptom duration longer than 2 weeks. Objective: We present an unusual case of chronic aortic dissection in a young patient, followed by a review of the literature on chronic aortic dissections and aortic dissections in young patients. Case Report: We report a case of chronic aortic dissection in a 32-year-old man with a history of untreated hypertension who presented to the ED with palpitations and mild shortness of breath. Conclusion: Acute and chronic thoracic aortic dissections can occur in patients of all ages, as well as in patients with atypical signs and symptoms.     

急性主动脉夹层16例临床特点及早期诊断的探讨

目的探讨急性主动脉夹层（AD）患者的易患因素、临床特点及诊断方法,以期提高该疾病的早期诊断水平。方法收集16例急性AD患者的临床资料,对其临床特点、辅助检查资料进行回顾性分析。结果AD患者临床表现多样,胸痛为常见首发症状,高血压是导致AD发生的常见原因。联合应用超声心动图（TTE）、CT和MRI 3种检查方法可以快速明确诊断。结论AD临床表现复杂,掌握其临床特征、保持高度的警惕并及时采取相关的检查是早期发现AD的关键。     

妊娠合并主动脉夹层6例回顾性分析

目的 探讨妊娠合并主动脉夹层的临床表现、诊断及治疗.方法 选取河南省人民医院于2015年1月至2020年12月收治的妊娠合并主动脉夹层患者6例,对其临床资料、治疗方案和母儿结局进行回顾性分析,探讨不同手术时机对妊娠合并主动脉夹层结局的影响.结果 6例年龄30～38岁,平均32.16岁.发病时间为孕5周至产后1个月,孕早...     

Descending Thoracic Aortic Aneurysm: Case Presentation and Review

This section is reserved for commentaries and brief essays dealing with matters of interest to physicians. Material for consideration should not exceed five double-spaced typewritten pages. An honorarium of $75 is offered at the time of publication. Submissions should be addressed to: Editor, POSTGRADUATE MEDICINE, 4530 W 77th St, Minneapolis, MN 55435.     

Silent Aortic Dissection after the Heimlich Maneuver: A Case Report

Background

The Heimlich maneuver is a simple and universal resuscitative procedure that is performed to relieve foreign-body airway obstruction. We present a case of silent Stanford type A aortic dissection, a rarely reported complication of the Heimlich maneuver.

外周血血细胞参数在急性主动脉夹层与急性心肌梗死鉴别中的价值

目的　探讨外周血血细胞参数在急性主动脉夹层（ acute aortic dissection, AAD）与急性心肌梗死（ acute myocardial infarction ,AMI）鉴别诊断中的价值。方法　回顾性分析 2019年 1~9月就诊于徐州医科大学附属医院急诊科并于入院后完善相关检查确诊为 AAD的患者 30例,AMI患者 30例,及同期健康体检者 20例外周血血细胞参数水平变化,利用 ROC曲线评估相关参数的诊断鉴别价值。结果　与 AMI组相比较, AAD组单核细胞（ monocyte,MON）和血小板平均体积 /血小板比值（ MPP）水平较高,血小板（ platelet,PLT）、血小板平均体积（ mean platelet volume, MPV）水平较低,差异均有统计学意义（ t=-2.363~3.890, 均 P<0.05）;与健康对照组相比, AAD组白细胞（ white blood cell,WBC）、中性粒细胞（ neutrophils,NEU）、MON,中性粒细胞 /淋巴细胞比值（ NLR）、血小板分布宽度（ Platelet distribution width,PDW）和 MPP均升高,淋巴细胞（ lymphocyte,LYM）、PLT和 MPV均降低,差异有统计学意义（t=-5.283~5.565,均 P<0.05）。MON,PLT,MPV和 MPP对 AAD和 AMI鉴别诊断的 ROC曲线下面积（ Area under curve, AUC）分别为 0.662,0.753,0.652和 0.664,联合 MON和 MPP的 AUC为 0.749,联合 MON,PLT和 MPV的 AUC为 0.872,四项联合检测的 AUC为 0.874;与单项指标检测相比四项联合检测 AUC最大,敏感度为 80.00%,特异度为 86.67%。结论　应用 MON+PLT+MPV+MPP四项联合检测鉴别诊断 AAD与 AMI优于单项指标检测,有望在临床推广应用。     

主动脉夹层患者术前血压控制的护理

目的：探讨主动脉夹层患者术前血压控制的护理经验。方法：回顾性分析了我院2007年1月至2008年1月收治的91例主动脉夹层患者血压控制的护理措施。结果：本组病例通过密切的观察和护理,获得了较好的治疗效果。结论：主动脉夹层患者术前血压控制的过程中,应密切观察,综合分析,采取镇静、止痛、扩血管等措施,才能有效地控制血压,为下一步治疗赢得时间和机会。     

不同年龄急性主动脉夹层患者发病时间的比较

目的比较不同年龄的急性主动脉夹层(acute aortic dissection,AAD)患者的发病时间,以期为因人、因时施护提供客观依据。方法回顾性分析2002年1月至2011年12月在扬州大学临床医学院确诊治疗的、有明确发病时间记载的287例AAD患者的临床资料。根据患者的年龄分为中青年组(65岁)和老年组(≥65岁),对其发病时间进行圆形分布图分析。结果中青年组AAD患者发病存在明显的月份集中趋势,集中月份在9月29日至次年2月18日,高峰月在12月9日;同时存在明显的时间集中趋势,集中时间在6:49至16:19,高峰时间在11:34。老年组AAD患者发病无月份集中趋势,发病呈均匀分布,但存在明显的时间集中趋势,集中时间在6:06至14:43,高峰时间在10:25。不同年龄组患者的发病时间的差异有统计学意义(F=6.197,P0.05)。结论中青年AAD患者的发病时间与老年患者不同,防治侧重不一样,有针对性地做好中青年与老年患者的时间护理,有助于更好地防范AAD的发生。     

Racial and Socioeconomic Disparities in the Presence of Acute Type A Aortic Dissections

Nonadherence to hypertensive medications is the most common predisposing factor associated with acute aortic dissections. Acute dissections are more likely to occur in African Americans due to higher rates of uncontrolled hypertension. Through a patient case study, the effects of racial and socioeconomic disparities will be illustrated. Through discussing the case of a 39-year-old African American man who presented with hypertensive crisis and nonadherence to hypertension treatment resulting in the diagnosis of an acute aortic dissection. His case exemplifies the effect of health disparities on postoperative outcomes, morbidity, and mortality in the African American population diagnosed with aortic dissections.