急性主动脉夹层临床与影像学诊断研究

【目的】探讨急性主动脉夹层 (AD)临床特点和诊断。【方法】回顾性分析深圳市 5家医院 1995～ 2 0 0 1年收治的5 0例AD患者的临床资料。【结果】长期高血压是AD的主要原因 ,4 5岁以下发病占 18% ;76 %患者表现有剧烈的胸前疼痛 ,亦有隐痛、无痛和剧痛后缓解 ;双上肢和上下肢血压异常差异占 12 % ;主动脉瓣舒张期杂音占 8% ;以并发症急性主动脉分支急性闭塞造成器官缺血坏死或压迫症状为首发症状出现的有急性心肌梗塞 (AMI)、单瘫、截瘫、急性左心衰等 ,亦有少见的气胸和中等量以上心包积液 ;影像检查电子计算机断层 (CT)、磁共振显像 (MRI)、经胸超声心动图 (TTE)有很高的敏感性 ,AD的分型、定位MRI较TTE优 ,而TTE在确定有无主动脉瓣损害、心包积液及观察内膜片活动等方面占优。【结论】AD的临床表现多样、复杂 ,临床医师必须对AD的临床表现及发病机制有清楚认识 ,及时选择或联合应用CT、MRI、TTE等辅助检查是AD确诊的重要手段

A Study on Clinical Characteristics Specificity and Image Diagnosis of Acute Aortic Dissection

To explore the clinical characteristics and image diagnosis of acute aortic dissection (AD) Clinical data of 50 patients with AD who were hospitalized into 5 hospitals in Shenzhen city from 1995 to 2001 were analyzed retrospectively The main cause of AD was hypertension for a long duration 18% of cases was less that 45 years old at the onset of the disease 76% of cases had severe pain on anterior pectoral region Some cases complained of vague pain, no pain and pain relieved after violent pain 12% of cases showed differences in blood pressure between two upper limbs or between upper and lower limbs 8% of cases had diastolic murmur in aortic valve area The first manifestation of necrosis and ischemia of organs resulted from acute occlusion of aortic branches consisted of AMI, monoparesis, paraplegia, acute left cardiac failure, etc The rare manifestations, such as pneumothorax or pericardial effusion might also be found Image examinations, including CT, MRI and transthoracic echocardiogram (TTE) had high sensitivity on diagnosis of AD MRI was the best one in classification and localization of AD, and TTE was the best in identification of aortic valve injury, pericardial effusion and observing the action of intimae [Conclusion] The clinical manifestations of AD are varied and complicated Physicians must understand the clinical features and pathogenesis of AD clearly It is important to choose one or all of CT, MRI and TTE for the diagnosis of AD