130例主动脉夹层临床分析及与肺栓塞的鉴别

发布时间：2018-05-11 17:55

本文选题：主动脉夹层 + 肺栓塞　；参考：《广西医科大学》2012年硕士论文

【摘要】：目的：分析主动脉夹层患者临床特征,并与同期入院的肺栓塞患者进行相关比较,探讨主动脉夹层的危险因素、早期诊断、临床误诊情况,通过对照分析以期发现能快速鉴别肺栓塞方法。方法：本研究分两个部分,采用回顾性分析方法,第一部分选取广西医科大学第一附属医院2003年11月至2011年8月最终确诊为主动脉夹层的130例患者,按Stanford分型分A、B两型,对其病史、发病特点、临床表现、体格检查、实验室及器械检查、疾病转归进行分析；第二部分将夹层组患者与同期入院的177名肺栓塞患者进行对照,比较分析两组的临床特征、伴随疾病、以及相关临床检查。数据处理采用SPSS13.0统计软件。结果：主动脉夹层患者平均年龄(52.98±12.61)岁,男女比例5.84：1,冬春为高发季节。以疼痛为首发症状者占84.62%(110/130),StanfordA型患者的马凡综合症、心包积液、晕厥、神志模糊的发生率以及死亡率要高于Stanford B型患者,差异有统计学意义(P均0.05)；而高血压发生率Stanford B型患者要高于Stanford A型患者,差异有统计学意义(P0.05)。胸部X线片显示主动脉增宽迂曲、上纵隔增宽、心影增大、单侧胸腔积液,以及超声心动图探及内膜片、破口、心包积液、主动脉瓣不同程度返流对诊断AD有一定提示作用。对照分析主动脉夹层组与肺栓塞组各项指标,都是以中青年男性发病为主。夹层组高血压患病率、吸烟率要高于肺栓塞组(P值分别为0.000,0.002)。血红蛋白(P=0.046)、血清白蛋白(P＝0.000)、凝血酶原时间(P＝0.006)、纤维蛋白原(P=0.029)、尿素氮(P=0.020)、血清肌酐(P=0.009)在两组之间有统计学差异。超声心动图结果比较,夹层组主动脉根内径、室间隔厚度、左室后壁厚度大于肺栓塞组(P值均为0.000)。肺栓塞组的右室内径、右室流出道、主肺动脉内径要大于夹层组(P值分别为0.000,0.035,0.026)。结论：高血压和吸烟分别是发生夹层的危险因素,主动脉夹层和肺栓塞患者的临床表现多样,超声心动图可作为病情严重,血流动力学不稳定的疑似主动脉夹层患者,与肺栓塞鉴别诊断的首选器械检查方法。
[Abstract]:Objective: to analyze the clinical features of aortic dissection and compare it with the patients with pulmonary embolism (PE) admitted at the same time to explore the risk factors, early diagnosis and clinical misdiagnosis of aortic dissection. A comparative analysis was carried out to find a rapid method for differentiating pulmonary embolism. Methods: this study was divided into two parts. In the first part, 130 patients with aortic dissection were selected from the first affiliated Hospital of Guangxi Medical University from November 2003 to August 2011. The patients were divided into two types according to Stanford classification. The history, characteristics, clinical manifestation, physical examination, laboratory and instrument examination, and the outcome of the disease were analyzed. The second part compared the dissection group with 177 patients with pulmonary embolism admitted in the same period. The clinical features, concomitant diseases, and related clinical examinations were compared between the two groups. SPSS13.0 statistical software is used for data processing. Results: the average age of patients with aortic dissection was 52.98 卤12.61 years old. The ratio of male to female was 5.84: 1. The incidence of aortic dissection was high in winter and spring. The incidence and mortality of Marfan's syndrome, pericardial effusion, syncope, dizziness, and dizziness in patients with Stanford A with pain as the first symptom were higher than those with Stanford B. The incidence of hypertension in Stanford B patients was higher than that in Stanford A patients (P 0.05). Chest radiographs showed aortic widening and detour, superior mediastinal enlargement, cardiac shadow enlargement, unilateral pleural effusion, and echocardiographic findings of intimal film, rupture, pericardial effusion and aortic valve regurgitation to some extent in the diagnosis of AD. The indexes of aortic dissection group and pulmonary embolism group were mainly middle and young men. The prevalence of hypertension and smoking rate in the dissection group were higher than that in the pulmonary embolism group (P = 0.000 ~ 0.002). There were significant differences between the two groups in hemoglobin, serum albumin, prothrombin time, fibrinogen, urea nitrogen, serum creatinine, and serum creatinine. The results of echocardiography showed that the diameter of aortic root, the thickness of ventricular septum and the thickness of posterior wall of left ventricle in dissection group were higher than those in pulmonary embolism group (P = 0.000). The right ventricular diameter, right ventricular outflow tract and main pulmonary artery diameter in the pulmonary embolism group were higher than those in the dissection group (P = 0.000 ~ 0.035 ~ 0.026), respectively. Conclusion: hypertension and smoking are the risk factors of dissection. The clinical manifestations of aortic dissection and pulmonary embolism are various. Echocardiography can be used as suspected aortic dissection with severe condition and unstable hemodynamics. The first choice instrument examination method for differential diagnosis with pulmonary embolism.
【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R543.1;R563.5

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