主动脉夹层内科紧急救治及临床路径探讨

李晚泉+方长庚+涂军荣+梁建光+郑晓东

[摘要] 目的 分析内科治疗主动脉夹层（AD）患者的紧急诊疗方案，为挽救患者生命提供更好的指导。 方法 回顾性分析本院2010年1月～2013年10月收治的AD患者的临床资料，分析患者的诊断及治疗方法，并了解这些方式对患者预后的影响。 结果 患者经治疗30 min内，血压及心率控制在正常值范围；入院6 h内，患者收缩压均达到100～110 mm Hg标准，心率均达到60～75/min标准。住院期间8例患者因动脉瘤破裂死亡，1例猝死，治疗总有效率为88.46%。 结论 AD因临床表现不典型，容易造成漏诊、误诊，早期诊断且及时合理治疗是改善预后的关键，有利于降低患者的死亡率。

[关键词] 主动脉夹层；临床路径；内科治疗

[中图分类号] R543.1[文献标识码] B[文章编号] 1674-4721（2014）03（c）-0166-03

Emergency internal medical treatment of aortic dissection and the clinical pathway exploration

LI Wan-quan FANG Chang-geng TU Jun-rong LIANG Jian-guang ZHENG Xiao-dong

Sanshui Hospital Affiliated to Guangdong Medical College,Foshan 528100,China

[Abstract] Objective To analyze the emergency internal medical treatment method of aortic dissection so as to providing better guidance for saving patient′s life. Methods The AD patients accepted and treated in our hospital from January 2010 to October 2013 were retrospectively analyzed,and the diagnostic and treatment methods as well as the impacts on patient′s prognosis were analyzed. Results The patient′s blood pressure and heart rate were controlled in the range of normal value within 30 min of treatment;when admitted within 6 h,patients′ systolic blood pressure all reached 100-110 mm Hg standard,and heart rates all reached 60-75/min standard.During hospitalization,8 patients died from aneurysm rupture,and one case of sudden death,the overall treatment effective rate was 88.46%. Conclusion Due to atypical clinical manifestations,aortic dissection likely to cause misdiagnosis.Early diagnosis and timely reasonable treatment are the key to improve the prognosis,which will help reduce mortality of patients.

[Key words] Aortic dissection;Clinical pathway;Internal medical treatment

主动脉夹层（aortic dissection，AD）是心血管疾病的危重症之一。关于AD的病因，多由于主动脉内的血液经内膜局部撕裂口流入囊样变性的中层，形成夹层血肿，随着血流压力的驱动，逐渐在主动脉中层内扩展，在动脉内形成真假两腔，并沿着主动脉壁延伸剥离[1]。AD患者多呈现发病突然、发展迅速的特点，急性期病死率高，且患者的临床症状复杂多样，早期诊断困难，容易造成误诊及漏诊。因此，快速准确地对AD进行诊断及治疗，对保障患者生命安全意义重大。本研究结合本院对AD患者的临床治疗实践，以完善AD的内科诊疗体系为出发点，总结分析了78例AD患者的早期诊断方法、内科治疗方法及预后，旨在提高AD的早期确诊率，最终降低AD患者的死亡率。

1 资料与方法