Analysis of diagnosis and treatment for 40 cases with aortic dissection in emergency / 中国基层医药

ABSTRACT

Objective To investigate the clinical manifestations of aortic dissection (AD),the characteris-tics of early diagnosis and treatment,and the causes of misdiagnosis.Methods 40 cases of aortic dissection with clinical manifestations,auxiliary examination,clinical classification,emergency diagnosis and misdiagnosis were retro-spectively analyzed.Results Initial symptoms were severe chest pain and(or)low back pain in 25 patients;chest tightness,asthma,dyspnea in 4 cases(10.0%);Unexplained shock and collapse in 4 patients(10.0%);abdominal pain with abdominal discomfort in 4 cases(10.0%);1 case of limb numbness(2.5%);cough,fever and hemoptysis in 2 cases(5.0%).associated with blood pressure on both sides of the asymmetry,a difference of more than 10 mmHg in 10 cases(25.0%).Auxiliary examination9 cases of abnormal ECG,3 cases(6.6%)of the patients with acute inferior myocardial infarction,emergency chest CT scan in 10 cases,10 cases of emergency nuclear magnetic reso-nance,CT angiography in 20 cases,9 cases of bedside ultrasound;Respectively6 cases were misdiagnosed as acute coronary syndrome,1 case of cardiac insufficiency,2 cases of sever pneumonia,pancreatitis,cholecystitis,multiple organ dysfunction,1 case of renal failure,acute gastritis in 1 case;musdiagnosis time 1 day to 3 days.28 cases of covered stent in the treatment,the remaining 8 cases were transferred to surgical treatment and other conservative treatment,4 cases of death.Conclusion Aorta complicated and varied clinical manifestation,dangerous condition, improve the emergency physician of aortic dissection,open diagnostic thinking and timely diagnosis and differential diagnosis,according to the condition of reasonable selection of auxiliary examination,specific imaging examination is the key to reduce the misdiagnosis.