2018 年第 11 期 第 13 卷

急性主动脉夹层误诊为急性冠状动脉综合征临床分析

Clinical analysis of acute aortic dissection misdiagnosed of acute coronary syndrome

作者：吕雪雅魏明张素娟宋毓青

英文作者：

单位：100015首都医科大学附属北京地坛医院心内科

英文单位：

关键词：急性主动脉夹层；急性冠状动脉综合征；误诊

英文关键词：

• 摘要：

• 【摘要】目的    对急性主动脉夹层(AAD)误诊为急性冠状动脉综合征患者临床特征进行分析，提高对该病的认识，减少误诊。方法    回顾性分析2012年1月至2017年12月首都医科大学附属北京地坛医院收治的6例Stanford A型AAD患者的病历资料，患者确诊AAD前均首诊为急性冠状动脉综合征。对6例患者病史与临床表现、辅助检查与诊断、治疗与预后进行分析。结果    本组患者既往有高血压病1例，陈旧性心肌梗死1例，余4例体健。患者均因胸痛就诊，有3例合并后背放射痛。本组患者的心电图均有多导联ST-T改变，Ⅱ、Ⅲ、AVF导联ST段抬高0.1～0.3 mV 2例，Ⅱ、Ⅲ、AVF导联ST段压低1例，V4～V6导联ST段压低和/或T波低平、倒置3例。6例患者行冠状动脉造影，其中4例行主动脉CT血管造影。所有患者确诊后给予控制血压、心率治疗后，转至外院血管外科进一步诊治。结论    AAD患者心电图出现缺血或损伤性改变，极易误诊为急性冠状动脉综合征并给予不适当治疗，对首诊为急性冠状动脉综合征的患者，应警惕合并AAD的可能，并完善相关辅助检查予以明确，防止误诊。

• 【Abstract】Objective    To analyze the clinical features of patients with acute aortic dissection(AAD) misdiagnosed of acute coronary syndrome(ACS). Methods    From January 2012 to December 2017, 6 Stanford type A AAD patients with the initial misdiagnosis of ACS in Beijing Ditan Hospital, Capital Medical University were retrospectively analyzed. Clinical manifestations, laboratory results, treatments and prognosis were analyzed. Results    One patient was complicated with hypertension. One patients was complicated wity old myocardial infarction. All patients reported chest pain as the main symptom; 3 of them had back radiation pain. Electrocardiogram manifested multi-lead ST-T changes; 2 patients showed Ⅱ, Ⅲ, AVF lead ST-segment elevation 0.1-0.3 mV; 1 patient showed Ⅱ, Ⅲ, AVF lead ST-segment depression; 3 patients showed ST-segment depression or T-wave lowering/inversion of V4-V6 lead. All patients underwent coronary angiography and 4 of them had aortic CT angiography. Main therapeutic measures included blood pressure and heartbeat control and vascular surgical treatments. Conclusion    sAAD patients with ischemic or injury changes in electrocardiogram are likely to be misdiagnosed of ACS. In patients with initial diagnosis of ACS, adequate auxiliary examinations are necessary to exclude AAD.