Appelbaum A, Karp R B, Kirklin J W
Ann Surg. 1976 Mar;183(3):296-300. doi: 10.1097/00000658-197603000-00015.
One hundred eight patients with spontaneously developing thoracic aortic dissection were seen between 1966-1973, 78 of whom had acute dissection and 30 chronic. The age (49 vs 60 yrs) and incidence of hypertension (32% vs 71%) were significantly lower in the 56 patients in whom dissection originated in ascending aorta than in the 52 patients in whom the dissection originated in the upper descending aorta. The mortality rate in medically treated patients with acute ascending aortic dissection was 88%. Cardiac tamponade was the major cause of death. The mortality rate was significantly lower in those who were treated surgically (24%). Fifteen (54%) of the patients with ascending aortic dissection and significant aortic incompetence did not have aortic valve replacement and only two subsequently (53 and 92 months later) required valve replacement. Although the initial mortality in patients with acute descending aortic dissection treated medically and surgically was similar, the long term survival rate was higher in the surgically treated group. We conclude that ascending aortic dissection and descending aortic dissection have different clinical profiles and prognoses. Immediate surgical intervention is indicated in patients with acute ascending aortic dissection. Patients with acute descending aortic dissection can be treated medically initially followed by early elective operation.
1966年至1973年间共收治108例自发性胸主动脉夹层患者，其中78例为急性夹层，30例为慢性夹层。夹层起源于升主动脉的56例患者的年龄（49岁对60岁）和高血压发病率（32%对71%）显著低于夹层起源于降主动脉上段的52例患者。药物治疗的急性升主动脉夹层患者的死亡率为88%。心脏压塞是主要死因。手术治疗患者的死亡率显著较低（24%）。15例（54%）升主动脉夹层合并明显主动脉瓣关闭不全的患者未进行主动脉瓣置换，其中只有2例（分别在53个月和92个月后）随后需要进行瓣膜置换。虽然药物治疗和手术治疗的急性降主动脉夹层患者的初始死亡率相似，但手术治疗组的长期生存率更高。我们得出结论，升主动脉夹层和降主动脉夹层具有不同的临床特征和预后。急性升主动脉夹层患者应立即进行手术干预。急性降主动脉夹层患者可先进行药物治疗，随后尽早进行择期手术。
