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生死一線間－狡猾多變的主動脈剝離
Case Report: Between life and death - cunning and changeable aortic dissection
摘要
研究背景：主動脈剝離是一種具有高度致死率且極為複雜的心臟血管疾病，其狡猾多變的臨床表現，容易讓救護技術員（Emergency Medical Technicians, EMT）誤判，是到院前緊急救護中罕見但棘手的疾病。個案簡介：本案為急病救護，患者為64歲女性，主訴於家中突然意識改變、有手麻發抖等情形，且有高血壓病史，近期曾抱怨過胸痛及背痛。身體檢查發現患者有左側肢體無力、言語不清及瞳孔不等大等異常發現，血糖檢測為正常。綜合身體檢查與現病史，無法排除急性心肌梗塞（Acute myocardial infarction, AMI）與腦血管意外（Cerebrovascular accident, CVA）的可能，緊急後送至重度級急救責任醫院，最終確診為A型主動脈剝離進行緊急手術。研究結論：主動脈剝離典型的臨床症狀為胸部突發性劇痛、像刀割般的撕裂痛感，隨剝離的位置不同，疼痛表現的位置也會有所變化。本案患者的求救原因、主訴與身體檢查發現與主動脈剝離典型症狀大相徑庭，導致現場EMT思路被引導朝向AMI或CVA發展。本篇案例透過文獻回顧，也提醒EMT疾病在臨床上的表現相當多元，而到院前要建立正確的診斷並非易事，在有更多證據佐證前，應對各種可能鑑別診斷抱持開放且懷疑的態度，對患者整體預後與EMT專業形象將有所助益。
並列摘要
Background: Aortic dissection is a highly complex cardiovascular disease characterized by a significant mortality rate. The various clinical presentations can easily cause Emergency Medical Technicians (EMTs) clinical decision making in pre-hospital settings. Case Description: A 64-year-old female patient complained a sudden alteration in consciousness, accompanied by hand numbness and trembling. She had a history of hypertension and had recently complained of chest pain and back pain. The physical examination revealed that the patient presented with left-sided limb weakness, slurred speech, and anisocoria, among other abnormal findings, and blood glucose levels were within the normal range. Based on the physical examination and the patient's presenting symptoms, it was not possible to rule out the possibility of Acute Myocardial Infarction (AMI) and Cerebrovascular Accident (CVA). Therefore, the patient was urgently transported to a tertiary care hospital, and the final diagnosis was confirmed Type A Aortic Dissection, leading to emergency surgery. Discussion: Typical clinical symptoms of Aortic Dissection include a sudden, sharp, tearing chest pain, with the location of pain varying depending on the site of dissection. In this case, the patient's presenting symptoms and examination findings were markedly different from the typical symptoms of Aortic Dissection, leading the on-site EMT to initially consider AMI or CVA as possible diagnoses. This case, through a literature review, also serves as a reminder that diseases can present with diverse clinical features, and establishing an accurate diagnosis before arrival at the hospital is not always straight-forward. Therefore, it is crucial for EMT to maintain an open and questioning attitude towards various potential differential diagnoses until further evidence becomes available. This approach can significantly impact both the overall prognosis for the patient and the professional image of EMT.