经食管及经胸超声心动图在A型急性主动脉夹层早期诊断中的价值

目的探讨经食管及经胸超声心动图对Stanford A型急性主动脉夹层早期诊断的价值.方法对62例Stanford A型急性主动脉夹层患者行经食管及经胸超声心动图检查.比较两种检查方式的直接表征、间接表征及检查结果.结果经食管超声心动图检查示主动脉壁血块/主动脉内膜漂浮48例(77.4%),主动脉瓣反流43例(69.4%),心包积液25例(40.3%),升动脉内径>42 mm29例(46.8%),≥1项表征62例(100%),阳性检出率为100%;经胸超声心动图检查示主动脉壁血块/主动脉内膜漂浮39例(62.9%),主动脉瓣反流34例(54.8%),心包积液18例(29.0%),升动脉内径>42 mm22例(35.5%),≥1项表征46例(74.2%),阳性检出率为74.2%.经食管超声心动图检查≥1项表征检出率及阳性检出率显著高于经胸超声心动图检查(P<0.01).结论经食管超声心动图对Stanford A型急性主动脉夹层的早期诊断准确率明显高于经胸超声心动图检查,可避免肺气肿、肥胖等因素所致误诊漏诊的发生,提高诊断率.

The value of transesophageal and transthoracic echocardiography in early diagnosis of type A acute aortic dissection

Objective To explore the early diagnostic value of TEE and TTE in Stanford A type AAD.Methods 62 patients with type A AAD were examined by TEE and TTE.Compare the direct,indirect,and inspection results of the two inspection methods.Results TEE showed that 48 patients(77.4%)had aortic wall blood clots/aortic intima floating,43 patients(69.4%)had aortic regurgitation,25 patients(40.3%)had pericardial effusion,29 patients(46.8%)had ascending artery diameter>42 mm,62 patients(100.00%)had more than one or more manifestations.The positive detection rate was 100%.TTE showed that 39 patients(62.9%)had aortic wall blood clots/aortic intima floating,34 cases(54.8%)had aortic regurgitation,18 cases(29.0%)had pericardial effusion,22 cases(35.5%)ascending artery diameter>42 mm,46 cases(74.2%)had more than one or more manifestations.The positive detection rate was 74.2%.The detection rate and positive detection rate of TEE≥1 manifestations were significantly higher than those of TTE(P<0.01).Conclusions The early diagnosis accuracy of TEE for Stanford type A acute aortic dissection is significantly higher than that of TTE examination,which can avoid misdiagnosis and miss diagnosis due to emphysema and obesity,and improve the diagnosis rate.