伴发脑血管意外症状的主动脉夹层

目的分析主动脉夹层(AD)合并脑血管意外的病因及临床表现,探讨其机制,提高临床医生对该病的认识.方法结合文献对1例以脑血管意外为首发症状的AD进行临床分析.结果资料显示主动脉夹层合并脑血管意外的发病率为8.70%;以脑血管意外为首发症状的AD占6.73%;误诊为脑血管意外占误诊率的5.01%(20/399).结论对于合并突发疼痛、晕阙或休克的脑血管病患者,应及时行进一步检查,以除外伴发脑血管意外的AD.     

Aortic dissection. An autopsy experience

Aortic dissection was confirmed in 33 patients at autopsy at the University Hospital of the West Indies between 1975 and 1988. Twenty-five cases were acute and 8 chronic and the diagnosis was made antemortem in 5 cases overall. The high risk of rupture of proximal dissections involving the ascending aorta into the pericardial sac is clear, and the overriding importance of systemic hypertension is once again confirmed. An unusual finding was the higher proportion of females to males. A higher index of suspicion should permit an antemortem diagnosis and appropriate therapy in a larger proportion of patients.     

主动脉夹层19例

1临床资料2000-06/2004-05我院收治主动脉夹层19(男8,女11)例,年龄19～65(平均43)岁,病程30 min～7 a.经超声心动图、CT,MRI或尸检明确诊断.De BakeyⅠ型8例,Ⅱ型5例,Ⅲ型6例,其中急性期14例(Ⅰ型6例,Ⅱ型4例,Ⅲ型4例).合并高血压病15例,马凡综合征5例.     

主动脉夹层50例临床分析

目的 探讨主动脉夹层(AD)的临床表现,以便早期诊断和治疗,降低死亡率。方法 对50例AD患者的临床表现、影像学检查、治疗经过及死亡原因进行回顾性分析。结果 50例行心脏超声检查,确诊者43例(90％);21例行CT检查。21例诊断为主动脉夹层(100％);行磁共振显像(MRI)27例,均确诊为主动脉夹层(100％)。经治疗好转出院42例(84％),1例并发脑梗死且留有一侧肢体活动障碍后遗症。7例死亡(占14％)。结论 早期诊断,有效治疗是降低死亡率的关键,CT、MRI可提供可靠的确诊依据。     

急性A型主动脉夹层的主动脉弓部重建

主动脉夹层是一种凶险的心血管外科急症,其中急性A型主动脉夹层致死率最高,及时的诊断和治疗可显著降低病死率。随着主动脉外科的快速发展,主动脉夹层的治疗方法越来越多样化,除了传统的外科开放手术外,还出现了分支支架血管植入、杂交手术、主动脉腔内修复等技术。但是治疗方法越多,越能说明该疾病缺乏统一、简便、安全、有效的适合所有患者的手术方式。由于主动脉弓在解剖、功能及病理改变上的复杂性,人们对于弓部重建的最适策略一直争议不断。本文将目前开展的急性A型主动脉夹层弓部重建方法进行综述,并做简析。     

Aortic dissection in a young patient without any predisposing factors

Aortic dissection is rare in the pediatric and young adult population. We hereby present a case of a 17-year- old male patient, without any predisposing factors, who developed an aortic dissection. The initial presentation was acute abdominal pain with massive retroperitoneal hematoma. His clinical condition deteriorated rapidly, did not respond to surgical hemostasis, and died within 36 hours of admission. The major autopsy finding was dissection of the descending aorta, extending from 2 cm distal from the origin of the left Subclavian artery. Microscopically, the aortic sections showed intimal thickening and tearing, medial smooth muscle loss, which was replaced by fibrous tissue, fragmentation of elastic lamellae with widening of interlamellar spaces, and cystic medial degeneration. The morphological features represented degenerative changes of the aorta, which were unusual in such a young patient. The pathophysiology, predisposing factors and relevant reports in the literature of aortic dissection in young patients are reviewed.     

主动脉夹层分离2例治疗成功报告并文献复习

主动脉夹层分离,旧称主动脉瘤, 系指内因或外力作用下主动脉壁内膜破裂,血液通过内膜破口渗入主动脉壁的中层而形成血肿,血肿沿主动脉壁中层延伸剥离,故有人称之为主动脉夹层血肿, 是一种最危重心血管急症.本文详细报告了两例已成功治疗的病例并复习了相关文献.     

主动脉夹层(附8例分析并文献复习)

目的：探讨主动脉夹层的发病机理、临床特征、诊断要点、治疗方法及预后，以提高临床医生对本病的认识。方法：回顾性分析和总结我科收治确诊的8例主动脉夹层临床资料及104例文献复习。结果：本病临床表现复杂多样，8例患者经心脏彩色多普勒超声、螺旋CT、磁共振成像、数字减影血管造影得以确诊。早期治疗预后良好。结论提高对本病的认识，作好疑诊病人的鉴别诊断，可减少误诊漏诊率。心脏彩超、螺旋CT、磁共振成像、数字减影血管造影有帮助于明确诊断。     

主动脉夹层StanfordA型主动脉弓置换加降主动脉支架植入术深低温体外循环麻醉处理

目的:探讨主动脉夹层StanfordA型主动脉弓置换加降主动脉支架植入术深低温体外循环麻醉处理的安全性及处理策略。方法:回顾分析28例行主动脉夹层StanfordA型主动脉弓置换加降主动脉支架植入术患者临床资料,资料显示麻醉方式为静脉复合麻醉+体外循环(深低温)+选择性脑灌注(或无脑灌注)。根据停止体外循环20min内和30min后有无脑灌流,将患者依次分为有灌流组和无灌流组。比较不同情况下,有灌流组和无灌流组患者的近期疗效。结果:低温组停止体外循环在20min以内的患者中,有脑灌注组在近期转归的各项观察指标上与无脑灌注组均无明显差异(P>0.05)。而根据停止循环超过30 min后脑灌流有无分组,两组的近期转归指标差异显著(P<0.05)。结论:主动脉夹层StanfordA型主动脉弓置换加降主动脉支架植入术的麻醉处理采用全静脉麻醉复合深低温下停循环,可以降低了停循环后对机体的不利影响,缩短停机时间,顺利完成手术。减少相关并发症,促进患者恢复。     

Aortic aneurysm and dissection are not associated with an increased risk for giant cell arteritis/ polymyalgia rheumatica

It has recently been claimed that giant cell arteritis (GCA) is associated with a markedly increased risk of aortic aneurysm formation or rupture. In the present study, the opposite approach was taken, by looking for the incidence of GCA and polymyalgia rheumatica (PMR) in patients with aortic aneurysm, aortic dissection, or both (AA/D). The records of 315 consecutive patients admitted with the diagnosis of AA/D were reviewed. In addition, follow up information was obtained in 82 patients by examination in the outpatient clinic. After careful examination and assessment of clinical and laboratory data, it was found that none of the 82 patients who survived hospitalisation and were available for examination had GCA or PMR. Moreover, review of the retrospective data available from hospital records of the total consecutive 315 patients with AA/D failed to find any patient with a diagnosis of GCA/PMR. In conclusion, the present study did not find an increased prevalence of GCA/PMR among a cohort of Israeli patients with AA/D. Therefore, it is suggested that a thorough investigation aiming to diagnose GCA/PMR is not cost effective in most of the elderly patients presenting with AA/D.     

主动脉夹层与主动脉瘤手术的临床麻醉分析

目的:回顾性分析总结主动脉夹层与主动脉瘤外科手术的麻醉实施方案及重要脏器的保护方法。方法:分析33例行升主动脉替换、全弓替换加支架象鼻手术患者的麻醉方法以及术中监测、循环管理、内环境调控和脑、肾、血液保护的情况。结果:本组病例中,平均体外循环时间(245±49)min,术中平均失血量(2150±820)ml,平均输库血量(1870±490)ml。2例病人术后1周内有轻微神经系统症状,2例病人合并有急性肾功能衰竭,1例心包填塞行二次开胸止血,1例术后发生急性心肌梗死,并发症发生率18.1%。本组共有3例病人在术后早期死亡,死亡率9.9%。本组病例无麻醉死亡.结论:动脉夹层与主动脉瘤手术的麻醉应着重强调麻醉诱导及维持的平稳,循环功能的稳定,脑、肾、血液保护和机体内环境的平衡。