發(fā)布時間：2018-06-09 00:03

  本文選題：急性嚴(yán)重胸痛 + 主動脈瓣區(qū)舒張期雜音　； 參考：《臨床心血管病雜志》2017年08期

【摘要】：目的:探討急性嚴(yán)重胸痛伴主動脈瓣區(qū)舒張期雜音的心血管急危重癥患者的病因診斷、臨床特點和預(yù)后判斷。方法:收集急性嚴(yán)重胸痛伴主動脈瓣區(qū)舒張期雜音病例66例,分析其疾病診斷,觀察其臨床指標(biāo),記錄有無首診誤診以及嚴(yán)重臨床事件、住院期間死亡終點事件。結(jié)果:66例患者以急性主動脈夾層Stanford A型(32例,占48.5%)、急性心肌梗死(AMI)伴主動脈瓣關(guān)閉不全(28例,占42.4%)多見,少數(shù)為急性主動脈竇瘤破裂(6例,占9.1%)。stanford A型急性主動脈夾層組白細(xì)胞計數(shù)、D-二聚體、C-反應(yīng)蛋白明顯升高的占比較高;AMI伴主動脈瓣關(guān)閉不全組多有糖尿病史,以心電圖ST-T改變、肌鈣蛋白I(TnI)升高及左室射血分?jǐn)?shù)下降的比例較高;急性主動脈竇瘤破裂組以年輕患者突發(fā)嚴(yán)重心力衰竭及顯著BNP升高的更常見。急性主動脈竇瘤破裂組首診誤診率明顯高于急性主動脈夾層Stanford A型及AMI伴主動脈瓣關(guān)閉不全組。急性主動脈竇瘤破裂組病死率明顯低于急性主動脈夾層Stanford A型及AMI伴主動脈瓣關(guān)閉不全組。結(jié)論:臨床上急性嚴(yán)重胸痛診斷時應(yīng)高度關(guān)注主動脈瓣區(qū)舒張期雜音,警惕少見疾病,避免誤診,正確判斷預(yù)后;尤其是D二聚體或CRP顯著升高的患者,需注意非AMI的可能。
[Abstract]:Objective: to investigate the etiological diagnosis, clinical features and prognosis of acute severe chest pain with aortic regional diastolic murmur. Methods: 66 cases of acute severe chest pain with aortic diastolic murmur were collected, the diagnosis of the disease was analyzed, the clinical indexes were observed, the first diagnosis and serious clinical events were recorded, and the terminal events of death during hospitalization were recorded. Results among the 66 patients, 32 were acute aortic dissection A (48.5%), 28 were acute myocardial infarction (AMI) with aortic valve insufficiency (42.4%), 6 were acute aortic sinus aneurysm rupture. Patients with acute aortic dissection of type A (9.1%).stanford A) had a history of diabetes and ST-T changes in electrocardiogram (ECG) were more than those in the patients with acute aortic dissection (9.1%).stanford A), the white blood cell count and the C-reactive protein of D-dimer were significantly increased in the patients with acute aortic dissection and the patients with aortic valve insufficiency had a history of diabetes. The increase of TnI and the decrease of left ventricular ejection fraction were more common in patients with acute aortic sinus aneurysm rupture, especially in young patients with severe heart failure and significantly increased BNP. The misdiagnosis rate of acute aortic sinus aneurysm rupture group was significantly higher than that of acute aortic dissection type A group and AMI with aortic valve insufficiency group. The mortality of acute aortic sinus aneurysm rupture group was significantly lower than that of acute aortic dissection type A and AMI with aortic valve insufficiency. Conclusion: in the diagnosis of acute severe chest pain, attention should be paid to the diastolic murmur of aortic valve area, to avoid misdiagnosis and to judge the prognosis correctly, especially in patients with significantly elevated D-dimer or CRP, the possibility of non-AMI should be paid attention to.
【作者單位】： 華中科技大學(xué)附屬協(xié)和醫(yī)院心血管病研究所華中科技大學(xué)附屬協(xié)和醫(yī)院心內(nèi)科;華中科技大學(xué)附屬梨園醫(yī)院心內(nèi)科;
【基金】：國家自然科學(xué)基金資助(No:81470483)
【分類號】：R54

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