主动脉夹层的诊治分析

目的 :对主动脉夹层在基层医院诊断和治疗进行探讨。方法 :以常规 1 8导联心电图、胸部正侧位片、心脏及血管超声、胸腹部CT、心脏及血管磁共振等检查 ,诊断 6例主动脉夹层。起病后均有胸骨后撕裂样疼痛 ,部分伴有腹痛和腰痛 ,入院后确诊时间 2～ 4 8h不等。其中Ⅰ型 2例、Ⅲ型 3例、Ⅱ型 1例。给以镇静、镇痛、降压维持血压在 1 4 6 3～ 1 3 5/9 3～7 3kPa、降低心率维持心率在 56～ 6 0次 /min、对症处理。结果 :死亡 2例、存活 4例 ,有 1例累及三支头臂动脉 ,有 4例累及腹腔干、肠系膜上动脉、肾动脉 ,有 3例累及髂总动脉。结论 :主动脉夹层在基层医院诊断是难点 ,关键在于早期诊断 ,可直接关系到治疗经过和预后 ;易误诊为急性心肌梗死、大块肺栓塞、急腹症、心绞痛等 ,需注意。对胸腹痛病人仔细询问病史 ,观察疼痛部位、性质、变化 ,查体详细 ,仔细观察病程变化 ,做相关的必要检查 ,鉴别不清是否存在夹层时 ,不可溶栓和抗凝治疗 ,以免加重病情 ,不管夹层类型及最终治疗如何 ,内科保守治疗有较明显效果 ,可降低病死率 ,部分病人可治愈 ,并能为病人争取更多的手术时间

Analysis on Diagnosis and Treatment of Aortic Dissecting Aneurysm

Objective: To discuss the diagnosis and treatment of dissecting aneurysm in basic hospital. Methods: 6 cases of aortic dissecting aneurysm were diagnosed with routine ECG, X-ray of chest, cardiovascular ultrasonic Doppler, CT and MRI. The expectant treatments to all cases were treated with internal medicine. Results: 4 patients survived and 2 dead. 1 case involved with 3 branches of bronchiocephlic arteries. 4 involved with celiac trunk, superior mensenteric artery and renal artery. 3 involved with common iliac artery. Conclusions: It is hard to obtain the diagnosis of dissecting aneurysm in basic hospital. The key point might gain early diagnosis, which related with treatment and prognosis, according to symptoms, signs, manifestations and relative examinations. The conservative treatment of medicine could be obvious and also save time for operation.