主動脈剝離多樣性臨床表徵

急性主動脈剝離是主動脈所發生最嚴重的一種急症，死亡率極高，以往在發病最初48小時，每小時的死亡率高達1%；突發劇烈撕裂性的胸痛是最典型的症狀，隨著病程的進行，胸痛可以移行至背部、腹部與肢體，同時也造成許多不同的臨床表現，如心肌缺氧、心肌梗塞、頭暈、腦中風、暈厥、休克，腹腔動脈、腸繫膜動脈、腎動脈或脊椎動脈血流不足、肢體無力等；臨床醫師必須熟悉急性主動脈剝離的各種臨床表徵，藉著詳細的詢問病史、理學檢查與迅速安排適當的影像檢查，方能達到早期診斷與治療的目的。本文是中台灣一間社區醫院，近二年所診斷的五個急性主動脈剝離的病例，藉著仔細描述他們發病的症狀、徵候以及診斷過程，並比較一些國外文獻的報告，發現病人的臨床表徵與國外不盡相同，因此對急性胸痛病人的診斷，胸痛的性質、變化，與測量雙側肢體血壓、脈搏，及醫師的警覺性都很重要。

關鍵字

主動脈剝離；急性主動脈剝離；經食道心臟超音波檢查

並列摘要

In clinical practice, acute aortic dissection is the most common fatal cardiovascular emergencies that involves the aorta. It was associated with a mortality rate as high as 1% per hour during the first 48 hours after the onset of symptoms if untreated. Classical acute aortic dissection has been described as presenting with sudden, severe chest, back, or abdominal pain characterized as ripping or tearing in nature. However, not all acute aortic dissections present with classical symptoms, many cases with this disease were reported to have presented with diverse features and variable manifestations. The initial aortic tear and subsequent extension of dissection along the aorta can produce many clinical diseases, like myocardial ischemia, acute myocardial infarction, dizziness, stroke, syncope, shock, malperfusion of celiac, mesenteric renal or spinal artery, weakness of limbs. Attending physicians must have a high index of clinical suspicion for this condition, early diagnosis and treatment can be achieved by detailed history talking, physical examination and appropriate arrangement of imaging modalities. To promote continued improvement in the prompt recognition of acute aortic dissection, we present 5 patients who were diagnosed at a community hospital in central Taiwan in the recent 2 years, and compared their clinical manifestations with some other published papers.

並列關鍵字

Aortic dissection ； Acute aortic dissection ； Transesophageal echocardiography

國際替代計量

主動脈剝離多樣性臨床表徵

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