基层医院急性主动脉夹层救治策略(1)
[摘要] 目的 探讨急性主动脉夹层的易患因素、临床特点和基层医院救治策略。 方法 选择遂宁市中心医院2008年1月～2013年9月收治的急性主动脉夹层患者142例临床资料进行回顾性分析，研究其临床特点、影像学表现、治疗方式及效果。 结果 按Stanford分型，Stanford A型41例，Stanford B型101例。外伤所致2例，食管异物刺伤胸主动脉2例，马凡综合征2例，高血压者136例；所有病例均通过心脏大血管增强CT造影确诊。142例中完全内科保守治疗80例，死亡59例，自动出院放弃治疗11例；1例行开窗技术治疗；1例行杂交手术治疗；44例行主动脉腔内修复术，死亡1例，持续发热1例；外科手术治疗16例，死亡3例。 结论 本病死亡率高，原发性高血压为最常见的高危因素之一。对于主动脉夹层患者一经确诊，应在积极内科保守治疗的同时，根据不同的类型及并发症采取相应的外科手术、主动脉腔内修复术或杂交手术治疗，可显著提高患者的存活率。
[关键词] 主动脉夹层；临床分析；三分支主动脉支撑型覆膜支架；主动脉腔内修复
[中图分类号] R543.1[文献标识码] A[文章编号] 1673-7210(2014)04(c)-0032-04
Basic hospital treatment strategy of acute aortic dissection
LIU Jianping1 XIA Juan2 JING Yi3 ZHANG Yongheng1 CHEN Quan1 ZHOU Haining1 YANG Bo1
1.Department of Cardiovascular Surgery, Central Hospital of Suining City, Sichuan Province, Suining 629000, China; 2.Department of Pathology, Central Hospital of Suining City, Sichuan Province, Suining 629000, China; 3.Department of ICU, Central Hospital of Suining City, Sichuan Province, Suining 629000, China
[Abstract] Objective To discuss the risk factors, clinical characteristics and basic hospital treatment strategy of acute aortic dissection. Methods A retrospective analysis was made on the clinical data of 142 acute aortic dissection patients Central Hospital of Suining City from January 2008 to September 2013 were selected. The clinical characteristics, imaging manifestations, treatment method and effect were analyzed. Results According to Stanford types, 41 cases of Stanford A, 101 cases of Stanford B were found. 2 cases of trauma, 2 cases of thoracic aortic puncture, 2 cases of Marfan syndrome, 136 cases of high blood pressure were found. All the cases were confirmed by heart vascular enhancement CT angiography. 80 cases with complete internal medicine conservative treatment, 59 cases of death, 11 cases of hospital discharge automatically were found. 1 case with fenestration treatment, 1 case with hybrid operation treatment were found. 44 cases with endovascular repair, 1 case of death, 1 case with continuous fever were found. 16 cases with surgical treatment and 3 cases of death were found. Conclusion This disease has a high death rate and one of the high risk factors is primary hypertension. It is right to take the corresponding surgical operation, endovascular repair or hybrid operation according to different types and complications while carrying out conservative medical management actively to improve the patients' survival rate.
[Key words] Acute aortic dissection; Clinical analysis; Triple-branched aortic arch covered stent graft; Thoracic Endovascular aortic repair
主动脉夹层(aortic dissection，AD)是心胸外科最常见、最危险的主动脉疾病之一。由于AD临床表现多样、不同分型病情发展及临床特征不同，常被误诊、误治，早期明确诊断对预后尤为重要[1]。本研究对AD患者的临床资料及随访结果分析报道如下：
1 资料与方法
1.1 一般资料
选择遂宁市中心医院2008年1月～2013年9月收治的AD患者142例临床资料，其中男112例，女30例，男女比例约为4∶1；年龄16～85岁，平均(61.5±13.2)岁；按Stanford分型，Stanford A型41例，Stanford B型101例；142例患者中，外伤所致2例，食管异物刺伤胸主动脉2例，马凡综合征2例，高血压者136例(其中15例患者入院时表现为低血压或休克，7例患者入院时表现为正常血压)；124例患者有胸痛病史，以胸背部持续性疼痛为主，呈撕裂样疼痛；腰腹痛18例，黑曚或晕厥19例，心包积液22例，胸腔积液30例，血尿及(或)血肌酐升高27例。所有病例均通过心脏大血管增强CT造影(CTA)确诊。, http://www.100md.com(刘建平 夏娟 敬毅 张永恒 陈权 周海宁 杨波)
[关键词] 主动脉夹层；临床分析；三分支主动脉支撑型覆膜支架；主动脉腔内修复
[中图分类号] R543.1[文献标识码] A[文章编号] 1673-7210(2014)04(c)-0032-04
Basic hospital treatment strategy of acute aortic dissection
LIU Jianping1 XIA Juan2 JING Yi3 ZHANG Yongheng1 CHEN Quan1 ZHOU Haining1 YANG Bo1
1.Department of Cardiovascular Surgery, Central Hospital of Suining City, Sichuan Province, Suining 629000, China; 2.Department of Pathology, Central Hospital of Suining City, Sichuan Province, Suining 629000, China; 3.Department of ICU, Central Hospital of Suining City, Sichuan Province, Suining 629000, China
[Abstract] Objective To discuss the risk factors, clinical characteristics and basic hospital treatment strategy of acute aortic dissection. Methods A retrospective analysis was made on the clinical data of 142 acute aortic dissection patients Central Hospital of Suining City from January 2008 to September 2013 were selected. The clinical characteristics, imaging manifestations, treatment method and effect were analyzed. Results According to Stanford types, 41 cases of Stanford A, 101 cases of Stanford B were found. 2 cases of trauma, 2 cases of thoracic aortic puncture, 2 cases of Marfan syndrome, 136 cases of high blood pressure were found. All the cases were confirmed by heart vascular enhancement CT angiography. 80 cases with complete internal medicine conservative treatment, 59 cases of death, 11 cases of hospital discharge automatically were found. 1 case with fenestration treatment, 1 case with hybrid operation treatment were found. 44 cases with endovascular repair, 1 case of death, 1 case with continuous fever were found. 16 cases with surgical treatment and 3 cases of death were found. Conclusion This disease has a high death rate and one of the high risk factors is primary hypertension. It is right to take the corresponding surgical operation, endovascular repair or hybrid operation according to different types and complications while carrying out conservative medical management actively to improve the patients' survival rate.
[Key words] Acute aortic dissection; Clinical analysis; Triple-branched aortic arch covered stent graft; Thoracic Endovascular aortic repair
主动脉夹层(aortic dissection，AD)是心胸外科最常见、最危险的主动脉疾病之一。由于AD临床表现多样、不同分型病情发展及临床特征不同，常被误诊、误治，早期明确诊断对预后尤为重要[1]。本研究对AD患者的临床资料及随访结果分析报道如下：
1 资料与方法
1.1 一般资料
选择遂宁市中心医院2008年1月～2013年9月收治的AD患者142例临床资料，其中男112例，女30例，男女比例约为4∶1；年龄16～85岁，平均(61.5±13.2)岁；按Stanford分型，Stanford A型41例，Stanford B型101例；142例患者中，外伤所致2例，食管异物刺伤胸主动脉2例，马凡综合征2例，高血压者136例(其中15例患者入院时表现为低血压或休克，7例患者入院时表现为正常血压)；124例患者有胸痛病史，以胸背部持续性疼痛为主，呈撕裂样疼痛；腰腹痛18例，黑曚或晕厥19例，心包积液22例，胸腔积液30例，血尿及(或)血肌酐升高27例。所有病例均通过心脏大血管增强CT造影(CTA)确诊。, http://www.100md.com(刘建平 夏娟 敬毅 张永恒 陈权 周海宁 杨波)