Moon Marc R
Division of Cardiothoracic Surgery, Center for Diseases of the Thoracic Aorta, Washington University School of Medicine, 660 S. Euclid Avenue, Box 8234, Saint Louis, MO 63110, USA.
Surg Clin North Am. 2009 Aug;89(4):869-93, ix. doi: 10.1016/j.suc.2009.05.003.
Acute aortic dissection is a fatal disease if early diagnosis and institution of appropriate therapy are delayed. Unfortunately, the presentation of a dissection can be diabolical, leading to an initial misdiagnosis in more than 25% of patients. For type A dissections, surgical repair is essential because mortality rates approach 50% at 48 hours with expectant therapy alone. For type B dissections, medical management is successful in most patients, although a subset with complications or early dilation may benefit from newer endovascular techniques. The goal of this review is to summarize the diagnostic algorithm, initial therapeutic options, and long-term management regimen that offer patients with an acute aortic dissection the best chance for short-term and long-term survival. There is an emphasis on the specific practical approach that is applied at Washington University to patients who present with an aortic dissection.
急性主动脉夹层是一种致命性疾病，如果早期诊断和恰当治疗延迟，后果严重。不幸的是，夹层的临床表现可能十分复杂，超过25%的患者初诊时会被误诊。对于A型夹层，手术修复至关重要，因为仅采用保守治疗时，48小时内死亡率接近50%。对于B型夹层，大多数患者采用内科治疗有效，不过，一部分有并发症或早期扩张的患者可能会从更新的血管内技术中获益。本综述的目的是总结诊断流程、初始治疗选择和长期管理方案，为急性主动脉夹层患者提供短期和长期生存的最佳机会。重点介绍华盛顿大学针对主动脉夹层患者所采用的具体实用方法。
