摘要
目的探讨急性主动脉夹层动脉瘤(aorticdissectinganeurysm,ADA)患者的临床特征。方法回顾分析139例急性ADA患者的临床资料,并与同期急性冠脉综合征(acutecoronarysyndrome,ACS)患者进行对照,判断影响ADA早期诊断的主要因素。结果139例急性ADA患者中男女之比为3.79∶1(110/29);125例(89.9%)表现为剧烈的疼痛;发病时血压明显升高92例(66.2%);四肢血压不对称或一侧肢体脉搏消失70例(50.0%);可闻及心脏或周围血管杂音76例(54.7%);出现交感神经兴奋82例(59.0%);血清酶学阳性改变30例(21.6%);心电图(ECG)改变100例(71.9%);胸部X线片阳性变化105例(75.5%)。结论急性ADA临床表现复杂,出现心脏或周围血管杂音、四肢血压不对称或一侧肢体脉搏消失、胸部X线片阳性变化和剧烈的疼痛是鉴别ADA与ACS较有意义的指标,掌握其临床特征是提高早期诊断的关键。
Objective To study the clinical characters of acute aortic dissecting aneurysm (ADA) patients for elevating the early diagnostic level in emergency department.Methods The clinical data of 139 cases of acute ADA were analyzed retrospectively,and compared with the acute coronary syndrome (ACS).Evaluation is the major factor which affected the early diagnosis of ADA.Results Among 139 patients with ADA,male to female was 3 79 to1 (110/29).125 cases (89 9%) showed bursting pain.92 cases (66 2%) presented with obviously elevated blood pressure on the onset of the disease.70 cases (50 0%) were found asymmetry of extremities′ blood pressure or disappearance of the pulse of one side.76 cases (54 7%) could hear obvious heart or peripheral vascular murmur.82 cases (59 0%) showed sympathetic nerve excited.The positive changes of serum enzyme,ECG,and X-ray examination of the chest were 30(21 6%),100(71 9%) and 105(75 5%),respectively.Conclusion The symptoms and physical signs of acute ADA are complex.The heart or peripheral vascular murmur,asymmetry of extremities′ blood pressure or disappearance of the pulse of one side,X-ray changes of the chest,and serious pain were significant to differentiate ADA from ACS.Recognizing its clinical characteristic is the key problem to elevate the early diagnostic level.
出处
《中国全科医学》
CAS
CSCD
2005年第11期888-890,共3页
Chinese General Practice
