急诊床旁彩超诊断主动脉夹层21例临床分析

目的探讨急诊床旁彩色多普勒超声（彩超）在诊断主动脉夹层（aortic dissection,AD）中的临床应用价值。方法对2009年2月—2011年10月我院急诊收治经彩超检查确诊的21例AD的临床资料进行回顾性分析。结果高血压是导致AD的最常见原因,本组21例有明确高血压病史20例（95.24%）。21例均有剧烈疼痛病史,表现为突发的胸、背、腰或腹部疼痛;除1例为58岁老年妇女外,余均为中年男性,其中城镇居民2例（男、女各1例）,余19例均为男性外来务工人员。本组均在接诊后2 h内行急诊床旁彩超检查确诊AD,转外院经手术或螺旋CT动脉造影（CTA）、主动脉数字减影血管造影（DSA）等检查得到进一步证实,无误漏诊病例。结论彩超是一种无创、可床旁操作、不影响监护、便捷和准确有效的方法,可作为急性AD的首选检查方法,对急诊患者的早期诊断及治疗有极高的临床应用价值。

Clinical Analysis of Color Doppler Ultrasound Diagnosis of 21 Patients with Aortic Dissection at the Emergency Bedside

Objective To explore clinical effect of color doppler ultrasound in diagnosis of aortic dissection(AD) at the emergency bedside.Methods Clinical data of 21 patients with AD during February 2009 and October 2011 in emergency department diagnosed by color doppler ultrasound were retrospectively analyzed.Results Hypertension was the most common cause for aortic dissection,among 21 patients,20 patients(95.24%) had hypertension history.All the 21 patients had severe itai-itai disease history such as gusty thoracic,dorsal,abdominal or back pain;the patients were middle-aged males except one 58-year-old female,19 patients were male migrant workers while 2 patients were town residents(1 male,1 female).All the patients were diagnosed as having AD by color doppler ultrasound at the emergency bedside within 2 hours,and were confirmed by surgical approach,spiral CT arteriography(CTA) and digital subtraction angiography(DSA) in other hospitals.No misdiagnosis was reported.Conclusion Color doppler ultrasound is a non-invasive,accurate,convenient and effective way as the first option in diagnosis of acute AD.