急性严重胸痛伴主动脉瓣区舒张期杂音患者的临床分析

发布时间：2018-06-09 00:03

  本文选题：急性严重胸痛 + 主动脉瓣区舒张期杂音　； 参考：《临床心血管病杂志》2017年08期

【摘要】：目的:探讨急性严重胸痛伴主动脉瓣区舒张期杂音的心血管急危重症患者的病因诊断、临床特点和预后判断。方法:收集急性严重胸痛伴主动脉瓣区舒张期杂音病例66例,分析其疾病诊断,观察其临床指标,记录有无首诊误诊以及严重临床事件、住院期间死亡终点事件。结果:66例患者以急性主动脉夹层Stanford A型(32例,占48.5%)、急性心肌梗死(AMI)伴主动脉瓣关闭不全(28例,占42.4%)多见,少数为急性主动脉窦瘤破裂(6例,占9.1%)。stanford A型急性主动脉夹层组白细胞计数、D-二聚体、C-反应蛋白明显升高的占比较高;AMI伴主动脉瓣关闭不全组多有糖尿病史,以心电图ST-T改变、肌钙蛋白I(TnI)升高及左室射血分数下降的比例较高;急性主动脉窦瘤破裂组以年轻患者突发严重心力衰竭及显著BNP升高的更常见。急性主动脉窦瘤破裂组首诊误诊率明显高于急性主动脉夹层Stanford A型及AMI伴主动脉瓣关闭不全组。急性主动脉窦瘤破裂组病死率明显低于急性主动脉夹层Stanford A型及AMI伴主动脉瓣关闭不全组。结论:临床上急性严重胸痛诊断时应高度关注主动脉瓣区舒张期杂音,警惕少见疾病,避免误诊,正确判断预后;尤其是D二聚体或CRP显著升高的患者,需注意非AMI的可能。
[Abstract]:Objective: to investigate the etiological diagnosis, clinical features and prognosis of acute severe chest pain with aortic regional diastolic murmur. Methods: 66 cases of acute severe chest pain with aortic diastolic murmur were collected, the diagnosis of the disease was analyzed, the clinical indexes were observed, the first diagnosis and serious clinical events were recorded, and the terminal events of death during hospitalization were recorded. Results among the 66 patients, 32 were acute aortic dissection A (48.5%), 28 were acute myocardial infarction (AMI) with aortic valve insufficiency (42.4%), 6 were acute aortic sinus aneurysm rupture. Patients with acute aortic dissection of type A (9.1%).stanford A) had a history of diabetes and ST-T changes in electrocardiogram (ECG) were more than those in the patients with acute aortic dissection (9.1%).stanford A), the white blood cell count and the C-reactive protein of D-dimer were significantly increased in the patients with acute aortic dissection and the patients with aortic valve insufficiency had a history of diabetes. The increase of TnI and the decrease of left ventricular ejection fraction were more common in patients with acute aortic sinus aneurysm rupture, especially in young patients with severe heart failure and significantly increased BNP. The misdiagnosis rate of acute aortic sinus aneurysm rupture group was significantly higher than that of acute aortic dissection type A group and AMI with aortic valve insufficiency group. The mortality of acute aortic sinus aneurysm rupture group was significantly lower than that of acute aortic dissection type A and AMI with aortic valve insufficiency. Conclusion: in the diagnosis of acute severe chest pain, attention should be paid to the diastolic murmur of aortic valve area, to avoid misdiagnosis and to judge the prognosis correctly, especially in patients with significantly elevated D-dimer or CRP, the possibility of non-AMI should be paid attention to.
【作者单位】： 华中科技大学附属协和医院心血管病研究所华中科技大学附属协和医院心内科;华中科技大学附属梨园医院心内科;
【基金】：国家自然科学基金资助(No:81470483)
【分类号】：R54

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