Hagan P G, Nienaber C A, Isselbacher E M, Bruckman D, Karavite D J, Russman P L, Evangelista A, Fattori R, Suzuki T, Oh J K, Moore A G, Malouf J F, Pape L A, Gaca C, Sechtem U, Lenferink S, Deutsch H J, Diedrichs H, Marcos y Robles J, Llovet A, Gilon D, Das S K, Armstrong W F, Deeb G M, Eagle K A
University of Michigan, Ann Arbor, USA.
JAMA. 2000 Feb 16;283(7):897-903. doi: 10.1001/jama.283.7.897.
Acute aortic dissection is a life-threatening medical emergency associated with high rates of morbidity and mortality. Data are limited regarding the effect of recent imaging and therapeutic advances on patient care and outcomes in this setting.
To assess the presentation, management, and outcomes of acute aortic dissection.
Case series with patients enrolled between January 1996 and December 1998. Data were collected at presentation and by physician review of hospital records.
The International Registry of Acute Aortic Dissection, consisting of 12 international referral centers.
A total of 464 patients (mean age, 63 years; 65.3% male), 62.3% of whom had type A dissection.
Presenting history, physical findings, management, and mortality, as assessed by history and physician review of hospital records.
While sudden onset of severe sharp pain was the single most common presenting complaint, the clinical presentation was diverse. Classic physical findings such as aortic regurgitation and pulse deficit were noted in only 31.6% and 15.1% of patients, respectively, and initial chest radiograph and electrocardiogram were frequently not helpful (no abnormalities were noted in 12.4% and 31.3% of patients, respectively). Computed tomography was the initial imaging modality used in 61.1%. Overall in-hospital mortality was 27.4%. Mortality of patients with type A dissection managed surgically was 26%; among those not receiving surgery (typically because of advanced age and comorbidity), mortality was 58%. Mortality of patients with type B dissection treated medically was 10.7%. Surgery was performed in 20% of patients with type B dissection; mortality in this group was 31.4%.
Acute aortic dissection presents with a wide range of manifestations, and classic findings are often absent. A high clinical index of suspicion is necessary. Despite recent advances, in-hospital mortality rates remain high. Our data support the need for continued improvement in prevention, diagnosis, and management of acute aortic dissection.
急性主动脉夹层是一种危及生命的医疗急症，其发病率和死亡率很高。关于近期影像学和治疗进展对这种情况下患者护理及预后的影响，数据有限。
评估急性主动脉夹层的临床表现、治疗及预后。
病例系列研究，研究对象为1996年1月至1998年12月期间纳入的患者。在患者就诊时及医生查阅医院记录时收集数据。
国际急性主动脉夹层注册中心，由12个国际转诊中心组成。
共464例患者（平均年龄63岁；65.3%为男性），其中62.3%患有A型夹层。
通过病史及医生查阅医院记录评估就诊史、体格检查结果、治疗及死亡率。
虽然突然发作的剧烈锐痛是最常见的就诊主诉，但临床表现多种多样。分别只有31.6%和15.1%的患者出现诸如主动脉反流和脉搏缺失等典型体格检查结果，而且最初的胸部X线片和心电图常常没有帮助（分别有12.4%和31.3%的患者未发现异常）。61.1%的患者最初使用计算机断层扫描作为影像学检查方法。总体住院死亡率为27.4%。接受手术治疗的A型夹层患者死亡率为26%；未接受手术的患者（通常因年龄较大和合并症）死亡率为58%。接受药物治疗的B型夹层患者死亡率为10.7%。20%的B型夹层患者接受了手术；该组患者死亡率为31.4%。
急性主动脉夹层表现形式多样，常缺乏典型表现。需要高度的临床怀疑指数。尽管有近期的进展，但住院死亡率仍然很高。我们的数据支持有必要在急性主动脉夹层的预防、诊断和治疗方面持续改进。
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