论文摘要
目的了解主动脉夹层(Aortic dissection, AD)误诊的现状,提高对AD的诊断认识。方法采用文献研究方法,通过中国期刊网(www.cnki.net)全文数据库检索1995 年1 月到2004 年12 月发表的与AD 误诊有关的病例研究报告文献52篇,对被误诊的335 例AD 患者的误诊疾病、临床表现、辅助检查等进行了回顾性调查研究。用Χ2检验分析不同临床症状与AD 类型的关系。结果AD 患者临床症状多样。疼痛症状发生率最高(85.1%),以胸背痛居首,腹痛为其次。A、B 两型的对比研究显示:腹痛在B 型AD 的发生率较A 型高(P<0.05),晕厥在A 型AD 中更多见(P<0.01),其他症状发生率无明显差异。误诊疾病达32 种。前5 类疾病依次为冠心病144 例次(42.9%)、急腹症57例次(17.0%)、中枢神经系统病变15 例次(4.5%)、尿路结石14 例次(4.1%)、风心病13 例次(3.6%)。误诊为冠心病组中,心绞痛83 例次(57.6%),心肌梗死61 例次(42.4%);误诊为急腹症组中,胰腺炎33 例次(57.9%),胆石症和/或胆囊炎17 例次(29.9%),肠梗阻7 例次(12.2%);误诊为中枢神经系统疾病中,脑卒中11 例次(73.3%),脊髓炎4 例次(26.7%)。结论AD 的临床表现复杂,不具备特异性。AD 的误诊率高,误诊的疾病种类繁多。对胸痛、周围动脉阻塞征象,伴或不伴高血压的患者,应提防AD 的可能。结合影像学检查,可提高诊断率。
论文目录
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