Semsroth S, Dumfarth J, Schachner T, Grimm M, Domanovits H
Universitätsklinik für Herzchirurgie, Department Operative Medizin, Medizinische Universität Innsbruck, Anichstr. 35, 6020, Innsbruck, Österreich,
Med Klin Intensivmed Notfmed. 2014 Jun;109(5):371-84. doi: 10.1007/s00063-014-0391-y.
Acute aortic syndrome (AAS) is a life-threatening disease. Quick and accurate diagnosis is crucial. Patients should be transferred to a competence center without any delay as soon as AAS is suspected. Immediate onset of tearing chest pain, mediastinal widening on chest radiography and pulse/blood pressure differentials are predictive for aortic dissection. A CT scan is the diagnostic tool of choice; alternatively, in hemodynamically unstable patients echocardiography may be preferred. Associated mortality is excessively high within the first few days. Urgent surgical consultation should be obtained for all patients presenting with AAS. Initial medical therapy is aimed to reduce pain and decrease wall stress in the aorta. Aortic dissection involving the ascending aorta should be treated by immediate surgery. Aortic dissection limited to the descending or thoracoabdominal aorta should be treated medically, initially. However, when associated with complications, endovascular treatment is recommended. A symptomatic intramural hematoma, a penetrating atherosclerotic ulcer or pending aortic rupture are associated with a substantial risk. Therefore, surgical or endovascular therapy is recommended.
急性主动脉综合征（AAS）是一种危及生命的疾病。快速准确的诊断至关重要。一旦怀疑AAS，应立即将患者毫不延迟地转至有能力的中心。突发撕裂样胸痛、胸部X线显示纵隔增宽以及脉搏/血压差异对主动脉夹层具有预测意义。CT扫描是首选的诊断工具；另外，对于血流动力学不稳定的患者，超声心动图可能更受青睐。在最初几天内相关死亡率极高。所有出现AAS的患者都应紧急寻求外科会诊。初始药物治疗旨在减轻疼痛并降低主动脉壁应力。累及升主动脉的主动脉夹层应立即手术治疗。仅限于降主动脉或胸腹主动脉的主动脉夹层最初应进行药物治疗。然而，当出现并发症时，建议进行血管内治疗。有症状的壁内血肿、穿透性动脉粥样硬化溃疡或即将发生的主动脉破裂具有相当大的风险。因此，建议进行手术或血管内治疗。
