摘要
目的比较和分析确诊主动脉夹层动脉瘤(AD)和误诊病人的发病特点、临床过程和实验室检查以提高对该病的认识.方法选取1995年1月至2004年9月广东省农垦中心医院,2000年1月至2004年9月北大深圳医院收治的主动脉夹层病人33例.所有病人均经X线或彩色Doppler超声检查,疑诊AD的病人进一步经MRI、CT或DSA确诊,确诊标准为发现假腔或游离瓣.AD病人18例,男14例,女4例,年龄20～79岁,平均年龄(55.8±11.4)岁.误诊病人15例,男12例,女3例,年龄22-75岁,平均年龄(56.2±10.8)岁.结果确诊AD和误诊病人的年龄、性别、高血压、冠心病、胸痛、心脏异常杂音、胸腔积液、心包积液、平均收缩压、平均舒张压、白细胞计数、肌酸肌酶及同工酶和DeBakeyⅢ型无显著性差异(P＞0.05).两组病人周围大血管杂音、肢体血压不对称、ST段异常改变、心律失常、DeBakey Ⅰ型、Ⅱ型有显著性差异(P＜0.05).误诊为急性冠脉综合征的病人较确诊AD病人ST段改变的幅度、心律失常、白细胞计数、肌酸肌酶有明显差异(P＜0.01),而肌酸肌酶和肌钙蛋白无显著性差异(P＞0.05).结论 AD病人初始症状、发病过程、心电图变化、心肌酶学改变易误诊为急性冠脉综合征,需要与该病相鉴别.
Objective To compare the clinical characteristics, clinical course and laboratory findings of diagnosed and misdiagnosed cases of aortic dissection （AD）. Methods The data of 33 cases of AD were collected for a retrospective review. All the patients underwent examination with X-ray and B-type ultrasound, and diagnosis of the suspected cases was further veilfied CT and magnetic resonance imaging according to the criteria of presence of false lumen or free valves. Diagnosis of AD was established in 18 of the 33 patients, including 14 male and 4 female patients aged from 20 to 79 years with a mean of 55.8±11.4 years. Misdiagnosis occurred in 15 patients including 12 male and 3 female patients aged 22-75 years with a mean of 56.2± 10.8 years. Results No significant differences were found between the diagnosed and misdiagnosed groups in terms of age, sex, hypertension, coronary heart disease, chest pain, heart murmur, pericardial effusion, pleural effusion, average systolic and diastolic pressure, white blood cell count, creatine phosphokinase （CK） and its isoeazyme CK-MB, or De Bakey type Ⅲ （P〉0.05）. Significant differences in peripheral large blood vessel murmur, asymmetric blood pressure of the arm and leg, ST segment variation, arrhythmia, and De Bakey types Ⅰ and Ⅱ were noted between the two groups （P〈0.05）. In cases misdiagnosed as acute coronary syndrome, ST segment variation, creatine kinase, arrhythmia, and white blood cell count were significantly different from those in cases of diagnosed as AD （P〈0.01）, but CPK-MB and cardiac troponin I were comparable. Conclusion The initial symptoms, disease course, cardioelectrographic changes and creatine kinase of AD can be easily confused with those of acute coronary syndrome, and special attention should be given to their differentiation.
出处
《第一军医大学学报》
CSCD
北大核心
2005年第9期1172-1174,共3页
Journal of First Military Medical University
关键词
主动脉夹层
急性冠脉综合征
误诊
aortic dissection
acute coronary syndrome
misdiagnosis
