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目的:探讨主动脉夹层首发症状与内膜原发破口位置和撕裂范围的关系。方法:回顾性总结931例主动脉夹层患者的首发症状、疼痛部位、是否有转移性疼痛、撕裂范围等情况,分析不同症状与原发破口和撕裂范围的关系。结果:疼痛占夹层首发症状的91.2%,其中以胸痛(40.3%)、胸背痛(25.9%)和腹痛(11.7%)最多见,17.6%的患者合并有转移性疼痛。表现为无痛(包括晕厥、胸闷、气短)或仅为胸痛症状的患者以A型夹层多见(均P<0.05)。而以背痛、腹痛、腰痛等为首发症状的多见于B型夹层(均P<0.05),且此类患者的内膜撕裂终点多位于腹主动脉及以下血管,而首发症状为头、颈或咽喉部疼痛的患者夹层撕裂范围多局限于胸降主动脉。结论:主动脉夹层症状呈多样性特点,首发症状与原发破口位置和撕裂范围之间存在规律性,此有助于对急诊疑似主动脉夹层进行初步的诊断。
OBJECTIVE: To investigate the relationship between the first symptom of aortic dissection and the location of primary rupture of the intima and the scope of tearing. Methods: A retrospective review of 931 patients with aortic dissection in the first symptom, the pain site, whether there is metastatic pain, the scope of tearing, analysis of different symptoms and the primary breach and tear the scope of the relationship. Results: Pain accounted for 91.2% of the initial symptoms of dissection, with chest pain (40.3%), chest and back pain (25.9%) and abdominal pain (11.7%) the most common, and 17.6% patients had metastatic pain. A type of dissection was more common in patients with painless (including syncope, chest tightness, shortness of breath) or only symptoms of chest pain (all P <0.05). And the first symptom such as back pain, abdominal pain, back pain and so on were more common in type B dissection (all P <0.05), and the end point of endometrial tear in such patients were mostly located in the abdominal aorta and the following blood vessels, and the first symptom was head, Patients with neck or throat pain in the scope of dissection and more limited to the descending thoracic aorta. CONCLUSION: Aortic dissection is characterized by a variety of features. There is a regularity between the first symptom and the location of primary breach and the scope of tearing, which is helpful for the preliminary diagnosis of suspected suspected aortic dissection.