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：

主動脈夾層; 診斷; 誤診

DOI：

10.7507/1002-0179.20130423

Video：

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目的　認識主動脈夾層患者的急診癥狀，減少漏診與誤診。方法　對2006年1月－2012年7月21例急性主動脈夾層患者的首發癥狀、輔助檢查、臨床診斷進行回顧性分析，總結誤診的原因。結果　首發癥狀為劇烈胸痛和（或）腹痛15例（71.4%），胸悶、呼吸困難4例（19.0%），胸痛伴肢體偏癱1例（4.8%），無痛性暈厥1例（4.8%）。15例行心電圖檢查，10例（66.7%）異常；17例行急診胸部X線片檢查，7例（41.2%）異常；9例行急診增強螺旋CT檢察，均發現真假兩腔（100.0%）；10例行急診超聲心動圖檢查，8例（80.0%）見假腔形成；15例行心肌梗死3項（肌酸激酶同工酶、肌紅蛋白、肌鈣蛋白I）檢查，4例（26.7%）異常；12例行D-二聚體檢查，3例（25.0%）異常。15例急診擬診主動脈夾層，6例誤診為其他疾病。結論　主動脈夾層臨床表現復雜，提高認識及必要的輔助檢查有助于早期診斷。

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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3.	吳焱賢, 郭新友, 吳賽珠, 等. 主動脈夾層動脈瘤的超聲心動圖診斷[J]. 中國實用內科雜志, 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.	黃文軍, 葉君明, 鄭澤琪. 320例主動脈夾層誤診分析[J]. 實用臨床醫學, 2011, 12(5): 8-10.
8.	梁振濤, 郭軍, 余小平, 等. 33例主動脈夾層動脈瘤的誤診分析[J]. 第一軍醫大學學報, 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, 湯勇. 急性主動脈夾層急診診斷研究進展[J]. 華西醫學, 2011, 26(8): 1256-1258.
12.	李曉兵, 田建明, 王培軍, 等. 多層螺旋CT血管造影對腔內隔絕術后內漏的診斷價值[J]. 中華放射學雜志, 2004, 38(2): 184-187.
13.	鐘唐力, 劉啟榆, 王忠, 等. 多層螺旋CT血管造影對主動脈夾層的診斷價值及臨床應用[J]. 華西醫學, 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. 　吳焱賢, 郭新友, 吳賽珠, 等. 主動脈夾層動脈瘤的超聲心動圖診斷[J]. 中國實用內科雜志, 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. 　黃文軍, 葉君明, 鄭澤琪. 320例主動脈夾層誤診分析[J]. 實用臨床醫學, 2011, 12(5): 8-10.
8. 　梁振濤, 郭軍, 余小平, 等. 33例主動脈夾層動脈瘤的誤診分析[J]. 第一軍醫大學學報, 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, 湯勇. 急性主動脈夾層急診診斷研究進展[J]. 華西醫學, 2011, 26(8): 1256-1258.
12. 　李曉兵, 田建明, 王培軍, 等. 多層螺旋CT血管造影對腔內隔絕術后內漏的診斷價值[J]. 中華放射學雜志, 2004, 38(2): 184-187.
13. 　鐘唐力, 劉啟榆, 王忠, 等. 多層螺旋CT血管造影對主動脈夾層的診斷價值及臨床應用[J]. 華西醫學, 2012, 27(7): 1046-1049.

West China Medical Journal

Analysis of First Symptoms and Emergency Diagnosis of Aortic Dissection

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