Analysis of First Symptoms and Emergency Diagnosis of Aortic Dissection_West China Medical Journal

Authors：

LI Mengqin ,  CAO Xiaoping.

Department of Emergency, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan 637000, P. R. China;

Corresponding author：

CAO Xiaoping., Email: nanchong120@yahoo.com.cn

Keywords：

主动脉夹层; 诊断; 误诊

DOI：

10.7507/1002-0179.20130423

Video：

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目的　认识主动脉夹层患者的急诊症状，减少漏诊与误诊。方法　对2006年1月－2012年7月21例急性主动脉夹层患者的首发症状、辅助检查、临床诊断进行回顾性分析，总结误诊的原因。结果　首发症状为剧烈胸痛和（或）腹痛15例（71.4%），胸闷、呼吸困难4例（19.0%），胸痛伴肢体偏瘫1例（4.8%），无痛性晕厥1例（4.8%）。15例行心电图检查，10例（66.7%）异常；17例行急诊胸部X线片检查，7例（41.2%）异常；9例行急诊增强螺旋CT检察，均发现真假两腔（100.0%）；10例行急诊超声心动图检查，8例（80.0%）见假腔形成；15例行心肌梗死3项（肌酸激酶同工酶、肌红蛋白、肌钙蛋白I）检查，4例（26.7%）异常；12例行D-二聚体检查，3例（25.0%）异常。15例急诊拟诊主动脉夹层，6例误诊为其他疾病。结论　主动脉夹层临床表现复杂，提高认识及必要的辅助检查有助于早期诊断。

Citation： LI Mengqin,CAO Xiaoping.. Analysis of First Symptoms and Emergency Diagnosis of Aortic Dissection. West China Medical Journal, 2013, 28(9): 1348-1350. doi: 10.7507/1002-0179.20130423 Copy

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7.	黄文军, 叶君明, 郑泽琪. 320例主动脉夹层误诊分析[J]. 实用临床医学, 2011, 12(5): 8-10.
8.	梁振涛, 郭军, 余小平, 等. 33例主动脉夹层动脉瘤的误诊分析[J]. 第一军医大学学报, 2005, 25(9): 1172-1174.
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11.	徐平, 汤勇. 急性主动脉夹层急诊诊断研究进展[J]. 华西医学, 2011, 26(8): 1256-1258.
12.	李晓兵, 田建明, 王培军, 等. 多层螺旋CT血管造影对腔内隔绝术后内漏的诊断价值[J]. 中华放射学杂志, 2004, 38(2): 184-187.
13.	钟唐力, 刘启榆, 王忠, 等. 多层螺旋CT血管造影对主动脉夹层的诊断价值及临床应用[J]. 华西医学, 2012, 27(7): 1046-1049.

1. 　Mészáros I, Mórocz J, Szlávi J, et al. Epidemiology and clinicopathology of aortic dissection[J]. Chest, 2000, 117(5): 1271-1278.
2. 　von Kodolitsch Y, Schwartz AG, Nienaber CA. Clinical prediction of acute aortic dissection[J]. Arch Intern Med, 2000, 160(19): 2977-2982.
3. 　吴焱贤, 郭新友, 吴赛珠, 等. 主动脉夹层动脉瘤的超声心动图诊断[J]. 中国实用内科杂志, 2000, 20(5): 296-297.
4. 　Hagan PG, Nienaber CA, Isselbacher EM, et al. The International Registry of Acute Aortic Dissection (IRAD): new insights into an old disease[J]. JAMA, 2000, 283(5): 897-903.
5. 　Wheat MW, Palmer RF, Bartley TD, et al. Treatment of dissecting aneurysms of the aorta without surgery[J]. J Thorac Cardiovasc Surg, 1965, 50: 364-373.
6. 　Masuda Y, Yamada Z, Morooka N, et al. Prognosis of patients with medically treated aortic dissection[J]. Circulation, 1991, 84(Suppl 5): s7-s13.
7. 　黄文军, 叶君明, 郑泽琪. 320例主动脉夹层误诊分析[J]. 实用临床医学, 2011, 12(5): 8-10.
8. 　梁振涛, 郭军, 余小平, 等. 33例主动脉夹层动脉瘤的误诊分析[J]. 第一军医大学学报, 2005, 25(9): 1172-1174.
9. 　Hado HS, Scarpello JH, Barton T, et al. A case of thoracic aortic dissection presenting as lateral pleuritic chest pain[J]. Emerg Med J, 2005, 22(3): 229-230.
10. 　Nienaber CA, Eagle KA. Aortic dissection: new frontiers in diagnosis and management: Part I: from etiology to diagnostic strategies[J]. Circulation, 2003, 108(5): 628-635.
11. 　徐平, 汤勇. 急性主动脉夹层急诊诊断研究进展[J]. 华西医学, 2011, 26(8): 1256-1258.
12. 　李晓兵, 田建明, 王培军, 等. 多层螺旋CT血管造影对腔内隔绝术后内漏的诊断价值[J]. 中华放射学杂志, 2004, 38(2): 184-187.
13. 　钟唐力, 刘启榆, 王忠, 等. 多层螺旋CT血管造影对主动脉夹层的诊断价值及临床应用[J]. 华西医学, 2012, 27(7): 1046-1049.

West China Medical Journal

Analysis of First Symptoms and Emergency Diagnosis of Aortic Dissection

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