CAJ | 학술논문

目的探讨急性主动脉夹层(AAD)急诊诊断和治疗要点.方法分析总结2006年8月~2012年8月 AAD 患者63例急诊临床资料,根据症状、体征、螺旋 CT 血管造影(CTA)和超声心动图(UCG)确立诊断,给予速效、短效药物控制血压、心率和镇痛、镇静、对症支持治疗,之后 Standford A 型39例行外科急诊手术治疗,9例继续保守治疗,Standford B 型8例接受介入治疗,7例保守治疗.结果全部患者中男性62例(98.4%),女性1例(1.6%),伴有高血压的患者共61例(96.8%),疼痛累及胸部的患者占全部患者的59例(93.6%),双侧肢体动脉搏动不对称、血压差>20mmHg 者54例(85.7%),全部患者通过CTA和UCG检查确诊,入院至确诊时间26±17.53min,A型48例(76.2%),B型15例(23.8%).61例(96.8%)的患者平稳由急诊科转出,急诊科停留时间6.7±7.4h.A 型外科急诊手术治疗者1月死亡率20.5%,保守治疗死亡率45.6%.B 型患者1月死亡率为0%.结论对胸背痛伴有高血压且双侧肢体动脉搏动不对称的男性患者,应高度警惕 AAD;CTA 是诊断 AAD 的首选影像学方法,可以为制定进一步的治疗提供帮助;恰当的保守治疗可以降低 AAD 患者的急诊死亡风险;A 型首选外科急诊手术治疗,B 型可以选择保守治疗.
목적탐토급성주동맥협층(AAD)급진진단화치료요점.방법분석총결2006년8월~2012년8월 AAD 환자63례급진림상자료,근거증상、체정、라선 CT 혈관조영(CTA)화초성심동도(UCG)학립진단,급여속효、단효약물공제혈압、심솔화진통、진정、대증지지치료,지후 Standford A 형39례행외과급진수술치료,9례계속보수치료,Standford B 형8례접수개입치료,7례보수치료.결과전부환자중남성62례(98.4%),녀성1례(1.6%),반유고혈압적환자공61례(96.8%),동통루급흉부적환자점전부환자적59례(93.6%),쌍측지체동맥박동불대칭、혈압차>20mmHg 자54례(85.7%),전부환자통과CTA화UCG검사학진,입원지학진시간26±17.53min,A형48례(76.2%),B형15례(23.8%).61례(96.8%)적환자평은유급진과전출,급진과정류시간6.7±7.4h.A 형외과급진수술치료자1월사망솔20.5%,보수치료사망솔45.6%.B 형환자1월사망솔위0%.결론대흉배통반유고혈압차쌍측지체동맥박동불대칭적남성환자,응고도경척 AAD;CTA 시진단 AAD 적수선영상학방법,가이위제정진일보적치료제공방조;흡당적보수치료가이강저 AAD 환자적급진사망풍험;A 형수선외과급진수술치료,B 형가이선택보수치료.
Objective To explore the main points of the emergency diagnosis and treatment of acute aortic dissection. Method Analyzed and summarized the emergency clinical data of 62 patients with acute aortic dissection from August 2006 to August 2012,based on symptoms,signs,and CTA and UCG to establish the diagnosis. Give quick and short-acting drugs to control blood pressure,heart rate,and analgesic,sedative,symptomatic and supportive treatment. Then,the type A 39 cases received surgical emergency surgery,other 9 cases continue to conservation treatment. Type B 8 cases received interventional treatment,other 7 cases received conservation treatment. Results Male patients 62 cases(98.4%), female 1 cases(1.6%),61 cases(96.8%)with hypertension,chest pain 59 cases(93.6%),54 cases(85.7%) with arterial pulse asymmetry and the difference in blood pressure> 20mmHg of bilateral limbs,Al patient confirmed the diagnosis by CTA and UCG,the time from admission to be confirmed was 26±17.53min,type A was 48 cases(76.2%), type B was 15 cases(23.8%). 61 cases were smoothly transferred from the emergency department,the emergency department residence time was 6.7±7.4h. Monthly mortality of type A patients received surgical emergency surgery was 20.5%,conservation treatment mortality was 45.6%,mortality of type B patients was 0%. Conclusion For the male patients which sudden thoracodorsal pain associated with hypertension and bilateral limbs arterial pulse asymmetry,should be highly alert to AAD;CTA is the first choice imaging examination method to diagnosis AAD,could help develop further treatment;appropriate conservation treatment could reduce AAD patients emergency risk of death;type A preferred surgical emergency surgery, type B could choose conservative treatment.