von Kodolitsch Y, Schwartz A G, Koschyk D H, Nienaber C A
Abteilung Kardiologie Universitätsklinikum Hamburg-Eppendorf Martinistrasse 52 20246 Hamburg, Germany.
Z Kardiol. 2001 May;90(5):339-47. doi: 10.1007/s003920170163.
Despite the availability of modern imaging technology, 35% of aortic dissections remain undiagnosed in vivo because clinical criteria for aortic dissection are not available to date. The present study analyzed 250 patients with acute chest and/or back pain, absence of an established differential diagnosis of the pain syndrome and clinical suspicion of acute aortic dissection for presence of 26 clinical variables. Multivariate analysis identified an aortic pain syndrome with immediate onset and/or tearing or ripping character (P < 0.0001), mediastinal and/or aortic widening on chest radiography (P < 0.0002) and pulse- and/or blood pressure differentials (P < 0.0001) as predictors of acute aortic dissection. Probability of dissection was low (7%) with absence of all three variables, intermediate (31 and 39%, respectively) with isolated findings of "aortic pain" or "mediastinal widening", and high (> 83%) with either isolated "pulse- and/or blood pressure differentials" or any combination of the three variables. This model appears useful to improve selection of patients for emergency imaging of the thoracic aorta.
尽管有现代成像技术，但由于目前尚无主动脉夹层的临床诊断标准，仍有35%的主动脉夹层在活体中未被诊断出来。本研究分析了250例急性胸痛和/或背痛患者，这些患者没有已确立的疼痛综合征鉴别诊断且临床上怀疑有急性主动脉夹层，分析了26项临床变量。多变量分析确定，具有突发起病和/或撕裂样特征的主动脉疼痛综合征（P < 0.0001）、胸部X线检查显示纵隔和/或主动脉增宽（P < 0.0002）以及脉搏和/或血压差异（P < 0.0001）是急性主动脉夹层的预测因素。若三项变量均不存在，夹层的概率较低（7%）；若单独出现“主动脉疼痛”或“纵隔增宽”，概率为中等（分别为31%和39%）；若单独出现“脉搏和/或血压差异”或三项变量的任何组合，概率则较高（> 83%）。该模型似乎有助于改善胸主动脉急诊成像患者的选择。
