主动脉夹层症状与原发破口位置、撕裂范围关系的探讨
Investigation of the relationship between symptoms of aortic dissection and location of initial intimal tears or dissection range

徐昶,贺行巍,李柱锡,乔平,刘婉君,刘玉建,高波,沈振军,曾和松.主动脉夹层症状与原发破口位置、撕裂范围关系的探讨[J].内科急危重症杂志,2015,21(4):

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英文关键词:aortic dissection symptom painless migrating pain

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作者	单位	E-mail
徐昶	华中科技大学同济医学院附属同济医院心内科	foreversun96@163.com
贺行巍	华中科技大学同济医学院附属同济医院心内科
李柱锡	华中科技大学同济医学院附属同济医院心内科
乔平	华中科技大学同济医学院附属同济医院心内科
刘婉君	华中科技大学同济医学院附属同济医院心内科
刘玉建	华中科技大学同济医学院附属同济医院心内科
高波	华中科技大学同济医学院附属同济医院心内科
沈振军	华中科技大学同济医学院附属同济医院心内科
曾和松	华中科技大学同济医学院附属同济医院心内科	zenghesong@163.com

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中文摘要:

目的探讨主动脉夹层首发症状与内膜原发破口位置和撕裂范围的关系。方法对2003年至2013年在武汉同济医院就诊的931例主动脉夹层患者进行回顾总结,收集并统计首发症状、疼痛部位、是否有转移性疼痛、撕裂范围等情况,分析不同症状与原发破口和撕裂范围的关系。结果疼痛占夹层首发症状的91.2%,其中以胸痛(40.3%)、胸背痛(25.9%)和腹痛(11.7%)最多见, 17.6%的患者合并有转移性疼痛。表现为无痛(包括晕厥、胸闷、气短)或仅为胸痛症状的患者以A型夹层多见(均P<0.05)。而以背痛、腹痛、腰痛等为首发症状的多见于B型夹层(均P<0.05),且此类患者的内膜撕裂终点多位于腹主动脉及以下血管,而首发症状为头、颈或咽喉部疼痛的患者夹层撕裂范围多局限于胸降主动脉。结论主动脉夹层症状呈多样性特点,首发症状与原发破口位置和撕裂范围之间存在规律性,此有助于对急诊疑似主动脉夹层进行初步的诊断。

英文摘要:

Object: The purpose of this study was to investigate the relationship between initial symptoms of Aortic dissection (AD) and location of initial intimal tears or dissection range. Method: The clinical data of 931 AD patients admitted to Tongji hospital (Wuhan, China) from 2003 to 2013 were retrospectively reviewed. Information about the patients’ initial symptoms, location of the pain, migration of the pain, classification of AD and dissection range were used. The relationship between symptoms and location of initial intimal tears or dissection range was analyzed. Result: Pain was the major clinical symptom in 91.2% patients. Among them, chest pain was 40.3%, chest and back pain was 25.9%, abdominal pain was 11.7% and migrating pain was 17.6%. Compared with Stanford type B AD, painless (syncope, chest congestion or shortness of breath) or chest pain alone were more common in type A AD (all P<0.05); whereas back, abdominal or waist pain were predominant in type B AD (all P<0.05). Furthermore, most endpoint of the dissection in those patients with back, abdominal and (or) waist pain was located below the abdominal aorta. In contrast, the tear was located at the thoracic descending aorta when patients suffer with head, neck and (or) throat pain. Conclusion: Symptoms of AD showed diversity. There might be connection between initial symptoms and location of initial intimal tear or dissection range. Our investigation would contribute to preliminarySdiagnosis of suspected aortic dissection.