Department of Cardiothoracic and Vascular Surgery, University of Texas Medical School, Memorial Hermann Heart and Vascular Institute, 6400 Fannin Street Suite 2850, Houston, TX 77030, USA.
Cardiol Clin. 2010 May;28(2):317-23. doi: 10.1016/j.ccl.2010.01.012.
Acute aortic dissection remains the most common of all aortic catastrophes and is associated with significant morbidity and mortality. Urgent surgical intervention should be considered in all patients with acute type A aortic dissection. Immediate repair is performed for those who are hypotensive due to rupture and tamponade and who exhibit malperfusion of the coronary, cerebrovascular, visceral, or peripheral arterial systems. Selective delayed management with eventual repair may be assumed in patients with type A intramural hematoma and in those with coma (potential neurologic devastation), assuming that neurologic status improves. Urgent repair should not be precluded in patients presenting with active stroke, older age, and previous cardiac surgery. Ultimately, each patient should be individualized and the decision to intervene left to the surgeon.
急性主动脉夹层仍然是所有主动脉灾难中最常见的一种，与显著的发病率和死亡率相关。所有急性 A 型主动脉夹层患者都应考虑紧急手术干预。对于因破裂和填塞而低血压并伴有冠状动脉、脑血管、内脏或外周动脉系统灌注不良的患者，应立即进行修复。对于 A 型主动脉壁内血肿和昏迷（潜在的神经损伤）患者，可以选择延迟治疗，最终进行修复，但前提是神经状态有所改善。对于有急性脑卒中、高龄和既往心脏手术的患者，不应排除紧急修复。最终，每个患者都应个体化，手术干预的决策应留给外科医生。
