急性主动脉夹层63例急诊诊治分析尚云波孙海燕张留定李华（云南省第三人民医院急诊科650011）【摘要】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StandfordA型39例行外科急诊手术治疗，9例继续保守治疗，StandfordB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。【关键词】急性主动脉夹层急诊诊断治疗【中图分类号】R54【文献标识码】A【文章编号】2095-1752（2013）04-0387-02TheAnalysisOfEmergencyDiagnosisAndTreatmentOf62AcuteAorticDissectionCasesSHANGYunbo,SUNHaiyan,ZHANGLiuding,LIHuaDepartmentofEmergency,ThePeople,sThirdHospitalofYunnanProvince,Kunming650011，China【Abstract】ObjectiveToexplorethemainpointsoftheemergencydiagnosisandtreatmentofacuteaorticdissection.MethodAnalyzedandsummarizedtheemergencyclinicaldataof62patientswithacuteaorticdissectionfromAugust2006toAugust2012,basedonsymptoms，signs,andCTAandUCGtoestablishthediagnosis.Givequickandshort-actingdrugstocontrolbloodpressure，heartrate,andanalgesic,sedative,symptomaticandsupportivetreatment.Then，thetypeA39casesreceivedsurgicalemergencysurgery,other9casescontinuetoconservationtreatment.TypeB8casesreceivedinterventionaltreatment，other7casesreceivedconservationtreatment.ResultsMalepatients62cases(98.4%)，female1cases(1.6%),61cases(96.8%)withhypertension，chestpain59cases(93.6%)，54cases(85.7%)witharterialpulseasymmetryandthedifferenceinbloodpressure>20mmHgofbilaterallimbs，AllpatientconfirmedthediagnosisbyCTAandUCG，thetimefromadmissiontobeconfirmedwas26±17.53min，typeAwas48cases(76.2%),typeBwas15cases(23.8%).61casesweresmoothlytransferredfromtheemergencydepartment，theemergencydepartmentresidencetimewas6.7±7.4h.MonthlymortalityoftypeApatientsreceivedsurgicalemergencysurgerywas20.5%,conservationtreatmentmortalitywas45.6%，mortalityoftypeBpatientswas0%.ConclusionForthemalepatientswhichsuddenthoracodorsalpainassociatedwithhypertensionandbilaterallimbsarterialpulseasymmetry,shouldbehighlyalerttoAAD;CTAisthefirstchoiceimagingexaminationmethodtodiagnosisAAD,couldhelpdevelopfurthertreatment；appropriateconservationtreatmentcouldreduceAADpatientsemergencyriskofdeath；typeApreferredsurgicalemergencysurgery，typeBcouldchooseconservativetreatment.【Keywords】AcuteaorticdissectionEmergencyDiagnosisTreatment随着国内高血压和动脉粥样硬化患者的日渐增多，AAD逐渐成为我国各级医院急诊科常见的严重威胁患者生命健康的心血管疾病，夹层的扩展可累及多个器官和系统，造成继发性缺血和压迫病变，临床表现复杂多样，急诊漏诊率可高达39%[1],基层医院漏诊率甚至高达89.2%[2]，若未给予适当的急诊治疗，48h内死亡率约为36%-71%[3],我们总结分析63例AAD患者...