A型主动脉夹层 - 近端

紧急程度高
-极为严肃

由于其最近端部分的主动脉内层破裂,这是一种严重的疾病。主动脉是体内最大的血管。

确切的原因尚不清楚,但已经描述了危险因素,如动脉内脂肪斑块的积聚,高血压,吸烟,主动脉瘤,胸部创伤,遗传性疾病,既往心脏手术,妊娠和血管炎。

它表现为非常强烈的胸痛(通常被描述为令人心碎)可以辐射到背部和肩胛骨。此外,身体的其他区域可能会出现疼痛,例如颈部,手臂,下颌,腹部和/或臀部。其他伴随症状:焦虑,死亡,头晕,昏厥,恶心和呕吐,皮肤出冷和出汗,脉搏微弱和快速,不对称脉搏,窒息,腹痛和吞咽困难。

通过指导性临床病史和完整的体格检查进行诊断。重要的是触摸和评估身体两侧的脉冲以研究不对称性。确认诊断将通过计算机断层扫描获得。

最终治疗是紧急手术。疼痛和相关的高血压应该用镇痛药和抗高血压药来控制。

参考文献
  1. Warren J Manning, James H Black, III. Clinical features and diagnosis of acute aortic dissection. UpToDate. Sep 14, 2016.
  2. Y Joseph Woo, Christina L Greene. Overview of open surgical repair of the thoracic aorta. UpToDate. Aug 02, 2016.
  3. Nienaber CA, Eagle KA. Aortic dissection: new frontiers in diagnosis and management: Part I: from etiology to diagnostic strategies. Circulation 2003; 108:628.
  4. Nienaber CA, Eagle KA. Aortic dissection: new frontiers in diagnosis and management: Part II: therapeutic management and follow-up. Circulation 2003; 108:772.
  5. Hiratzka LF, Bakris GL, Beckman JA, et al. 2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM guidelines for the diagnosis and management of patients with Thoracic Aortic Disease: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, American Association for Thoracic Surgery, American College of Radiology, American Stroke Association, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of Thoracic Surgeons, and Society for Vascular Medicine. Circulation 2010; 121:e266.
  6. Mark A. Creager, Joseph Loscalzo. Enfermedades de la aorta. Harrison. Principios de Medicina Interna. Volumen 2. 19º Edición. 1637:1643
  7. Virgilio Martínez Mateo, María Lázaro Salvador, Luis Rodríguez Padial. Síndrome aórtico agudo. Manual de protocolos y actuación en urgencias. Hospital Virgen de la Salud, Complejo Hospitalario de Toledo. Tercera edición. 2010. 309:312.
作者
医生 Oscar Garcia-Esquirol
版权
© TeckelMedical 2026

症状

    身体两侧脉搏强度不同


    像是被扎一样的背部疼痛


    低血压


    可以想象到的疼痛极点


    呼吸短促的感觉