摘要
目的探讨急性主动脉夹层(aortic dissection,AD)患者的临床特点及误诊原因,并提出防范措施。方法回顾性分析1例误诊为急性心肌梗死(acute myocardial infarction,AMI)的AD患者临床资料,并检索中国期刊全文数据库2001—2015年收录的相关误诊文献,检索式为"主动脉夹层"关键词检索加"误诊"模糊检索,分析命中文献的临床特点及误诊原因。结果 1本例因突发胸痛伴左背部剧烈疼痛入院。心电图示心房颤动并多导联ST段弓背样抬高,就诊期间因室性心动过速(室速)突发意识丧失,予体外电复律后室速终止,初步考虑AMI,急行经皮冠状动脉介入术,术中冠状动脉造影排除AMI诊断。后行主动脉螺旋CT造影确诊为AD(Stanford A型),转心胸外科行主动脉夹层腔内隔绝术。但因患者心功能极差,术后18 d抢救无效死亡。2文献检索共命中73篇文献,累计误诊病例589例,症状以剧烈胸痛为主(57.9%),其次为剧烈腹痛、晕厥、神经系统症状、腰痛等;体征以血压升高为主(53.0%),其次为大汗、皮肤湿冷、休克、血压降低等。前5位误诊疾病为AMI、心绞痛、急性胰腺炎、急性肠梗阻、急性脑卒中。结论 AD缺乏特异性临床表现,易误诊;对于突发持续性胸、腰、腹部剧痛的中老年人,应高度警惕AD的发生,尽早采用有效检查手段,迅速评估病情,合理处理,以降低病死率。
Objective To investigate clinical characteristics and misdiagnosed causes of acute aortic dissection （AD） , and to provide preventive measures. Methods Clinical data of one AD patient misdiagnosed as having acute myocardial infarction （AMI） was retrospectively analyzed, and related misdiagnosis literatures from 2001 to 2015 were searched from Chinese Journal Full-text database, and searched method was keyword search of aortic dissection and vague search of misdiagnosis, and then clinical characteristics and misdiaguosed causes of the involved literatures were analyzed. Results （1）The patient was admitted for gusty chest pain associated with severe pain in left side of back. Electrocardiogram result showed that atrial fibrillation combined with muti-lead humpback ST segment elevation. During the emergency visit, sudden loss of consciousness induced by ventricular tachycardia was found, and the symptom was stopped after following electric defibrillation. AMI was suspected, and percataneous coronary artery intervention was performed immediately, and then AMI was negated by intraoperative coronary arteriongraphy. CT angiography （CTA） examination was performed, and then the result was confirmed the diagnosis of AD （Stanford A）. Intracavitary isolation of aortic dissection was performed for patient, but the patient died at postoperative 18 d because of poor cardiac function. （2）A total of 73 literatures （589 misdiagnosed cases） were involved in this study, and the top symptoms were severe chest pain （57.9%） , severe abdominal pain, syncope, neurologic symptoms, lumbago and so on; the top signs were hypertension （53.0%） , sweat, skin cold clammy, shock, decreased blood pressure and so on. The top 5 misdiagnosed diseases were AMI, angina peetoris, acute pancreatitis, acute intestinal obstruction and acute cerebral apoplexy. Conclusion AD is lack of specificity and easily misdiagnosed, and therefore AD should be highly suspected for middle-elderly patients with pains in thorax, waist an
作者
牛磊
费爱华
吴增斌
王海嵘
高成金
潘曙明
NIU Lei FEI Ai-hua WU Zeng-bin WANG Hai-rong GAO Cheng-jin PAN Shu-ming(Department of Emergency Medi- cine, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School, Shanghai 200092, Chin)
出处
《临床误诊误治》
2016年第10期33-36,共4页
Clinical Misdiagnosis & Mistherapy
基金
上海市科学技术委员会基金项目(13ZR1426500)
关键词
动脉瘤
夹层
误诊
急性冠状动脉综合征
心肌梗死
Aneurysm, dissecting
Misdiagnose
Acute coronary syndrome
Myocardial infarction
