Upchurch Gilbert R, Nienaber Christoph, Fattori Rossella, Evangelista Arturo, Oh Jae, Cooper Jeanna V, Isselbacher Eric, Suzuki Toru, Eagle Kim A
University of Michigan Health System, Ann Arbor, MI 48109-0329, USA.
Ann Vasc Surg. 2005 May;19(3):367-73. doi: 10.1007/s10016-004-0171-x.
The objective of this study was to determine the morbidity and mortality of patients with acute thoracic aortic dissections who present primarily with abdominal pain. Nine hundred ninety-two patients (mean age, 62.1 years +/- 14.1; 68% male) encountered from 1996 to 2001 with acute thoracic aortic dissections from the International Registry of acute Aortic Dissection were studied. Patient demographics, presenting symptoms, signs of aortic dissection, aortic pathology, and mortality were compared in patients presenting primarily with abdominal pain (group I, 46 patients, 4.6%) versus all others (group II). Demographics were similar between the two groups. When signs of aortic dissection were examined, 63% of patients in group I presented with hypertension compared to only 47% of patients in group II (p = 0.04). Patients in group I were less likely to present with evidence of end-organ malperfusion. Importantly, mortality in patients with a type B dissection, specifically following surgery for the dissection, was significantly increased in patients who presented primarily with abdominal pain (group I, 28% mortality vs. group II, 10.2% mortality; p = 0.02). This study documented increased mortality in patients with acute thoracic aortic dissections who present primarily with abdominal pain, underscoring the importance of maintaining a high index of suspicion for an aortic dissection in patients who have appropriate risk factors.
本研究的目的是确定主要表现为腹痛的急性胸主动脉夹层患者的发病率和死亡率。对1996年至2001年期间从国际急性主动脉夹层注册中心收治的992例急性胸主动脉夹层患者（平均年龄62.1岁±14.1岁；68%为男性）进行了研究。比较了主要表现为腹痛的患者（第一组，46例，4.6%）与所有其他患者（第二组）的患者人口统计学特征、出现的症状、主动脉夹层体征、主动脉病理情况及死亡率。两组的人口统计学特征相似。检查主动脉夹层体征时，第一组63%的患者患有高血压，而第二组仅47%的患者患有高血压（p = 0.04）。第一组患者出现终末器官灌注不良证据的可能性较小。重要的是，主要表现为腹痛的患者（第一组）中，B型夹层患者（尤其是夹层手术后）的死亡率显著增加（第一组死亡率为28%，第二组死亡率为10.2%；p = 0.02）。本研究记录了主要表现为腹痛的急性胸主动脉夹层患者死亡率增加，强调了对有适当风险因素的患者保持高度怀疑主动脉夹层的重要性。
