主动脉夹层死亡16例临床特征分析

目的探讨主动脉夹层死亡患者的临床特点,以降低院内病死率。方法对2004年10月—2013年10月经影像学检查确诊为主动脉夹层且在住院期间死亡的16例临床资料进行回顾分析。结果 16例主动脉夹层临床表现多样,如剧烈的心前区疼痛、胸背部疼痛、心悸、憋气、大汗、晕厥等,其中以撕裂样胸背部疼痛多见。本组7例接受外科手术治疗,其中1例术中死亡,余6例死于术后并发症(感染、消化道大出血、多脏器功能衰竭等)。3例行降主动脉覆膜支架植入术,其中2例死于主动脉夹层破裂,1例死于术后消化道大出血。6例未接受外科治疗者均死于主动脉夹层破裂。结论早期识别主动脉夹层的高危患者,及时确诊、治疗,可显著减少术后并发症,降低院内病死率。

Clinical Characteristics of 16 Death Cases of Aortic Dissection

Objective To explore the clinical characteristics of death cases of aortic dissection in order to reduce fatality rate. Methods Clinical data of 16 death cases of aortic dissection confirmed by the iconography examination and died during the hospital stay during October 2008 and October 2013 was retrospectively analyzed. Results The symptoms of the 16death cases of aortic dissection were diverse such as the severe precordialgia,dorsal part of chest pain,palpitation,breathlessness,severe sweating and syncope,in which tearing-like dorsal part of chest pain was the most common. Seven patients underwent surgeries,and one died during the operation,6 patients died of postoperative complications（ infection,massive hemorrhage of gastrointestinal tract,multiple organ failure,etc）. Three patients received descending aorta of endovascular stentgraft treatment,during which two died of aortic dissection rupture,and one died of postoperative massive hemorrhage of gastrointestinal tract. Six cases did not undergo surgeries and died of aortic dissection rupture. Conclusion The incidence rates of postoperative complications and fatality rate in hospitals can be reduced by identifying high risk patients with aortic dissection,diagnosis and treatment as early as possible.