主动脉夹层误诊26例分析

目的 探讨主动脉夹层误诊的原因,以提高临床确诊率.方法 回顾分析2008年6月-2012年6月我院35例主动脉夹层中首诊误诊26例的临床资料.结果 本组26例均以突发疼痛为首发症状,其中首诊误诊为急性心肌梗死9例,心绞痛7例,急性胸膜炎、胆石症各3例,急性胰腺炎、消化性溃疡、肾结石、晕厥待查各1例,首诊误诊率74.29％.后经心脏彩色多普勒超声或胸、腹部螺旋CT增强扫描检查确诊为主动脉夹层,均予镇静、镇痛、控制血压等药物治疗,好转出院24例,2例死亡.随访3～6个月均无并发症及复发.结论 主动脉夹层临床表现复杂多样,易误诊.对临床高度怀疑主动脉夹层患者应详细询问病史、仔细查体,及时行相关医技检查,以降低误诊率.

Analysis of 26 Misdiagnosed Patients with Aortic Dissection

Objective To explore the misdiagnosis causes of aortic dissection in order to improve the clinical definite rate.Methods Clinical data of 26 misdiagnosed inpatients at the first visit among 35 inpatients with aortic dissection during June 2008and June 2012 were retrospectively analyzed.Results The first symptom of 26 patients was sudden pain,and 9 patients at the first visit were misdiagnosed as having acute myocardial infarction,7 as having angina pectoris,3 as having acute pleurisy,3 as having cholelithiasis,1 as having acute pancreatitis,1 as having peptic ulcer,1 as having kidney-stones and 1 as having suspicious syncope,and the misdiagnosis rate of first visit was 74.29％.All patients were confirmed aortic dissection by color Doppler ultrasound,thoracic or abdominal enhanced spiral CT scanning,and were treated with pharmacotherapies such as sedation,analgesia,blood pressure control,etc.Twenty-four patients were cured and discharged,and two patients died.There was no complication or recurrence with a follow-up for 3-6 months.Conclusion The clinical manifestations of aortic dissection is complex and may be misdiagnosed.Patients with suspicious aortic dissection should be carefully asked for medical history,and physical and related medical examinations should be taken in order to reduce the misdiagnosis rate.