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108例急性主动脉综合征的临床分析
Analysis of the clinical characteristics of acute aortic syndrome in 108 cases

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DOI:
作者:
吴春波
WU chunbo
作者单位:
北京大学人民医院急诊科
Peking University People’s Hospital beijing
关键词:
关键词 急性主动脉综合征 临床特征 治疗
Key words acute aortic syndrome clinical characteristics therapy
摘要:
摘要 目的：探讨急性主动脉综合征的临床特征 方法：回顾性总结我院2004年1月至2009年12月诊断的急性主动脉综合征108例患者的住院资料。 结果：在108例急性主动脉综合征患者中，主动脉夹层91例(84.3%)，穿透性主动脉溃疡9例（8.3%），主动脉壁间血肿8例(7.4%)，.病变累及升主动脉37例（34.3%），累及降主动脉71例（65.7%，。既往有高血压病史67例（62%），不规律服用降压药40例(60%)。急性主动脉综合征患者的临床表现与病变位置及范围有关，各型之间难以区分，疼痛是急性主动脉综合症的主要表现,本组典型表现突发的胸背痛占75例（69.4%）,表现为扩展性及（或）转移性疼痛72例（72.9%），无疼痛症状9例（8.3%）.。本组病例手术治疗为主，A型主动脉病变死亡率仍较高，手术死亡11例（40.7%）。B型主动脉病变主要采用腔内覆膜支架介入治疗，死亡2例（3.3%）。本组有8例（9%）手术后肾功能异常可能与造影剂的应用有关。 结论：高血压及不规则服药是急性主动脉综合征主要诱发因素，突发的转移性疼痛是其特征性表现，尽早确诊，恰当的治疗，可改善预后。 关键词 急性主动脉综合征 临床特征 治疗
Abstract Objective: To analyze the clinical characteristics of acute aortic syndrome. Methods: The clinical data of 108 in-patients of acute aortic syndrome admitted in our hospital from January 2004 to December 2009 were reviewed and analyzed. Results: Among 108 cases, 84.3% were aortic dissection and 8.3% penetrating atherosclerotic aortic ulcer, 7.4% were intramural aortic haematoma . Ascending aorta was compromised in 34.3% , and descending aorta was compromised in 65.7% . The risk factors of acute aortic syndrome were hyperlipidemia and hypertension. The clinical manifestations of acute aortic syndrome varied with the focus location, range, and there was no definite differentiation between types of acute aortic syndrome, though pain was their main presentation. Abrupt extending or transferring thoracic-back pain was only presented in 51.5% , and 8.3% cases were painless. Surgical operation was the main treatment in our 108 cases. The mortality of type A was much higher, with surgical mortality of 40.7% , while intervention with intra-lumen encapsulated stent was the treatment of type B, with mortality of 3.3% . Abnormal renal function after surgical operation was 9% , may be relating to the contrast. Conclusion: hypertension and irregular medicine-taking constitutes the dominant cause of acute aortic syndrome, characterized with Abrupt extending or transferring pain。It is necessary to give earliest diagnoses and treatment and better result can be expected.

 

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