中华急诊医学杂志
中華急診醫學雜誌
중화급진의학잡지
CHINESE JOURNAL OF EMERGENCY MEDICINE
2011年
6期
646-649
,共4页
熊光仲%赵金龙%柴湘平%彭再梅%张东山%毕长龙%范晓%邱双发%贺志飚%张宏亮%文铁%荣耀%向旭东%舒畅%周新民
熊光仲%趙金龍%柴湘平%彭再梅%張東山%畢長龍%範曉%邱雙髮%賀誌飚%張宏亮%文鐵%榮耀%嚮旭東%舒暢%週新民
웅광중%조금룡%시상평%팽재매%장동산%필장룡%범효%구쌍발%하지표%장굉량%문철%영요%향욱동%서창%주신민
主动脉夹层%急诊救治%临床分析%三联四程序化%路径
主動脈夾層%急診救治%臨床分析%三聯四程序化%路徑
주동맥협층%급진구치%림상분석%삼련사정서화%로경
Aortic dissection%Emergency treatment%Clinical analysis%Triple four procedures%Path
目的 探讨主动脉夹层(aortic dissection,AD)的临床特点与急诊救治方法及路径.方法 采用回顾性分析方法,收集2000年1月至2009年12月中南大学湘雅医院急诊科收治的784例主动脉夹层患者的临床资料等分别进行对比及统计分析,分析其存活率、病死率及有效率.结果 首发症状以痛疼为主占77.7%(609/784),原有高血压病史占86.5%(678/784).确诊至术前784例均行急诊内科救治,存活率81.5%(639/784),病死率18.5%(145/784),无效157例(20.0%),总有效率(83.1%),其中传统治疗有效率(76.4%),三联四程序化治疗有效率(89.8%)(P<0.05),差异具有统计学意义.在院急诊死亡139例(17.7%).其中24 h内死亡26例(18.4%),48 h内死亡47例(33.8%),72 h死亡66例(47.2%).确诊后拒绝治疗92例,其中72 h内死亡81例(88.04%),两组病死率相比较,具有统计学意义(P<0.05).结论 详细病史、体查及CT和MRI主动脉造影检查是诊断主动脉夹层的主要手段,镇痛、镇静、降压是急诊救治的重要方法.急诊早期确诊和有效救治为争取早期手术及进一步治疗赢得了时间,是提高AD生存率的关键.
目的 探討主動脈夾層(aortic dissection,AD)的臨床特點與急診救治方法及路徑.方法 採用迴顧性分析方法,收集2000年1月至2009年12月中南大學湘雅醫院急診科收治的784例主動脈夾層患者的臨床資料等分彆進行對比及統計分析,分析其存活率、病死率及有效率.結果 首髮癥狀以痛疼為主佔77.7%(609/784),原有高血壓病史佔86.5%(678/784).確診至術前784例均行急診內科救治,存活率81.5%(639/784),病死率18.5%(145/784),無效157例(20.0%),總有效率(83.1%),其中傳統治療有效率(76.4%),三聯四程序化治療有效率(89.8%)(P<0.05),差異具有統計學意義.在院急診死亡139例(17.7%).其中24 h內死亡26例(18.4%),48 h內死亡47例(33.8%),72 h死亡66例(47.2%).確診後拒絕治療92例,其中72 h內死亡81例(88.04%),兩組病死率相比較,具有統計學意義(P<0.05).結論 詳細病史、體查及CT和MRI主動脈造影檢查是診斷主動脈夾層的主要手段,鎮痛、鎮靜、降壓是急診救治的重要方法.急診早期確診和有效救治為爭取早期手術及進一步治療贏得瞭時間,是提高AD生存率的關鍵.
목적 탐토주동맥협층(aortic dissection,AD)적림상특점여급진구치방법급로경.방법 채용회고성분석방법,수집2000년1월지2009년12월중남대학상아의원급진과수치적784례주동맥협층환자적림상자료등분별진행대비급통계분석,분석기존활솔、병사솔급유효솔.결과 수발증상이통동위주점77.7%(609/784),원유고혈압병사점86.5%(678/784).학진지술전784례균행급진내과구치,존활솔81.5%(639/784),병사솔18.5%(145/784),무효157례(20.0%),총유효솔(83.1%),기중전통치료유효솔(76.4%),삼련사정서화치료유효솔(89.8%)(P<0.05),차이구유통계학의의.재원급진사망139례(17.7%).기중24 h내사망26례(18.4%),48 h내사망47례(33.8%),72 h사망66례(47.2%).학진후거절치료92례,기중72 h내사망81례(88.04%),량조병사솔상비교,구유통계학의의(P<0.05).결론 상세병사、체사급CT화MRI주동맥조영검사시진단주동맥협층적주요수단,진통、진정、강압시급진구치적중요방법.급진조기학진화유효구치위쟁취조기수술급진일보치료영득료시간,시제고AD생존솔적관건.
Objective To investigate the clinical features of aortic dissection (AD) and emergency treatments. Methods Data from 784 patients with aortic dissection were collected in the Department of Emergency from January 2000 through December 2009. A retrospective analysis was carried out to determine the survival rate, mortality rate and treatment efficiency. Results Pain was the most common onset symptom (77.7% , 609/784). The majority of patients (86.5%) had essential hypertension (678/784). All the patients with preoperative diagnosis of aortic dissection underwent emergency medical intervention by internists resulting in 81.5% survival rate (639/784) and 18.5% mortality rate (145/784). There were 157 patients without improvement (20.0% ) and the total efficiency rate was (83. 1% ). The efficiency rate of conventional treatment was 76.4% , while the efficiency rate of triple four-procedure treatment was 89. 8% (P<0.05). Of them, 139 patients (17. 7% ) died in the hospital. Among them,. 26 patients died within 24 hours (18.4% ) and 47 cases died within 48 hours (33. 8% ) and 66 patients died within 72 hours (47.2% ). There were 92 patients who refused treatments after diagnosis, and among them, 81 patients died within 72 hours (88.04% ). The difference in mortality rate between two groups was significant (P<0.05). Conclusions The diagnosis of aortic dissection depends on detailed history, physical examination and CT or MRI imaging. Analgesia, sedation and control of blood pressure are essential for emergency treatments. Early diagnosis and effective emergency treatments are the critical strategy for the early surgical intervention and time window for further treatment to improve the survival rate of AD.
