Early rapid diagnosis and rational choice of the first-line agents for acute aortic dissection in the emergency department: ses / 中华急诊医学杂志

ABSTRACT

Objective To explore the rapid diagnosis and the rational chice of the first-line agents for acute aortic dissection (AAD) in the emergency department.Methods The clinical data of 360 patients with AAD treated at our hospital from March 2007 to March 2013 were retrospectively analyzed.Of them,338 patients with suspected AAD were examined by chest radiography,trans-thoracic echocardiography (TTE),and computed tomography angiography (CTA) successively.The reliabilities of results from each diagnostic method were verified by the gold standard of intra-operative findings and the comparisons of their diagnostic potential were carried out.Results The preoperative diagnostic sensitivity of chest radiography,TTE and CTA in the assessment of AAD were 64％,77％ and 100％,respectively;the specificity is 86％,90％ and 100％,respectively;the accuracy rats were 70％,78％ and 100％,respectively;the positive predictive values were 93％,99％ and 100％,respectively;the negative predictive values were 46％,27％ and 100％,respectively.In the work-up of any patient with suspected AAD,the emergency bedside non-invasive TTE or computed tomography was the first-line initial diagnostic screening,and the best method for the accurate diagnosis of AAD was CTA.Medical management included pain control and deliberate hypotension therapy by using rapidly short-acting vasodilator and beta blockers to lower heart rate,and the hibernation therapy in small dose of specific agents might serve as a useful adjuvant method,and the early combination of vasodilatation medicines was better than the single one.Of them,242 patients fortunately survived on treatment,and 42 died of hypovolemic shock after rupture of AAD and multiorgan failure.Conclusions Acute aortic dissection is the most potentially life-threatening cardiovascular disease,though it is extremely rare in the hypertensive patients,attending doctors should pay more attention.Early rapid diagnosis is the key to AAD treatment.The best method for correctly diagnosing AAD is complementary use of TTE,CTA and magnetic resonance angiography (MRA).Correct and timely diagnosis and strictly deliberate hypotension treatment are the essential determinant of decreasing mortality and improving prognosis of AAD.