Meron Giora, Kürkciyan Istepan, Sterz Fritz, Tobler Karin, Losert Heidrun, Sedivy Roland, Laggner Anton N, Domanovits Hans
Department of Emergency Medicine, Universitätsklinik für Notfallmedizin, Allgemeines Krankenhaus der Stadt Wien, Währinger Gürtel 18-20/6D, AKH Wien, Vienna 1090, Austria.
Resuscitation. 2004 Feb;60(2):143-50. doi: 10.1016/j.resuscitation.2003.10.005.
To evaluate the frequency, presentation and outcome of non-traumatic aortic dissection/rupture as a cause of cardiac arrest.
Retrospective analysis of a cardiac arrest registry in a tertiary care hospital emergency department.
Over 11.5 years, aortic dissection/rupture was identified as the immediate cause of cardiac arrest in 46 (2,3%) out of 1990 patients with sudden cardiac arrest, primarily affecting the abdominal aorta in 25 and the thoracic aorta in 21 cases. The characteristics of the 46 patients were as follows: male gender (74%), median age 71 years (IQR 59-76), high co-morbidity (89%), previously known aortic aneurysm (33%), pulseless electric activity (70%) as initial cardiac rhythm. When performed, bedside abdominal sonography or echocardiography was almost always diagnostic. Patients with abdominal aortic dissection/rupture had abdominal (52%) and/or flank pain (32%). Patients with thoracic aortic dissection/rupture complained of chest pain (48%) or dyspnoea (19%). Return of spontaneous circulation occurred in 12 (26%) of 46 patients, emergency surgery was performed in eight of these patients, 2 (4%) survived to discharge in good neurological condition.
Cardiac arrest caused by aortic dissection/rupture is rare, and mortality remains very high, even when circulation can be restored initially. Common features such as previously known aortic aneurysm, old age, male gender and pulseless electrical activity as initial cardiac rhythm should increase suspicion of the condition.
评估非创伤性主动脉夹层/破裂作为心脏骤停原因的发生率、表现及转归。
对一家三级医院急诊科心脏骤停登记处进行回顾性分析。
在11.5年期间，1990例心搏骤停患者中，有46例（2.3%）被确定心脏骤停的直接原因是主动脉夹层/破裂，其中25例主要累及腹主动脉，21例累及胸主动脉。这46例患者的特征如下：男性（74%），年龄中位数71岁（四分位间距59 - 76岁），合并症多（89%），既往有主动脉瘤病史（33%），初始心律为无脉电活动（70%）。床边腹部超声或超声心动图检查若实施，几乎总能确诊。腹主动脉夹层/破裂患者有腹痛（52%）和/或胁腹疼痛（32%）。胸主动脉夹层/破裂患者主诉胸痛（48%）或呼吸困难（19%）。46例患者中有12例（26%）恢复自主循环，其中8例接受了急诊手术，2例（4%）存活出院，神经功能良好。
主动脉夹层/破裂导致的心脏骤停罕见，即使最初能恢复循环，死亡率仍然很高。既往有主动脉瘤病史、老年、男性及初始心律为无脉电活动等常见特征应增加对此病的怀疑。
