Axelsson Christer, Karlsson Thomas, Pande Katarina, Wigertz Kristin, Örtenwall Per, Nordanstig Joakim, Herlitz Johan
1University of Borås,School of Health Science,Borås,Sweden.
2Institute of Internal Medicine,Department of Metabolism and Cardiovascular Research,Sahlgrenska University Hospital,Gothenburg,Sweden.
Prehosp Disaster Med. 2015 Apr;30(2):155-62. doi: 10.1017/S1049023X15000060. Epub 2015 Feb 10.
Aortic dissection is difficult to detect in the early phase due to a variety of symptoms. This report describes the prehospital setting of aortic dissection in terms of symptoms, treatment, and suspicion by the Emergency Medical Service (EMS) staff.
All patients in the Municipality of Gothenburg, Sweden, who, in 2010 and 2011, had a hospital discharge diagnosis of aortic dissection (international classification of disease (ICD) I 71,0) were included. The exclusion criteria were: age<18 years of age and having a planned operation. This was a retrospective, descriptive study based on patient records. In the statistical analyses, Fisher's exact test and the Mann-Whitney U test were used for analyses of dichotomous and continuous/ordered variables.
Of 92 patients, 78% were transported to the hospital by the EMS. The most common symptom was pain (94%). Pain was intensive or very intensive in 89% of patients, with no significant difference in relation to the use of the EMS. Only 47% of those using the EMS were given pain relief with narcotic analgesics. Only 12% were free from pain on admission to the hospital. A suspicion of aortic dissection was reported by the EMS staff in only 17% of cases. The most common preliminary diagnosis at the dispatch center (31%) and by EMS clinicians (52%) was chest pain or angina pectoris. In all, 79% of patients were discharged alive from the hospital (75% of those that used the EMS and 95% of those that did not).
Among patients who were hospitalized due to aortic dissection in Gothenburg, 78% used the EMS. Despite severe pain in the majority of patients, fewer than half received narcotic analgesics, and only 12% were free from pain on admission to the hospital. In fewer than one-in-five patients was a suspicion of aortic dissection reported by the EMS staff.
由于存在多种症状，主动脉夹层在早期难以被检测出来。本报告从症状、治疗以及紧急医疗服务（EMS）工作人员的怀疑等方面描述了主动脉夹层的院前情况。
纳入了瑞典哥德堡市在2010年和2011年出院诊断为主动脉夹层（国际疾病分类（ICD）I 71.0）的所有患者。排除标准为：年龄<18岁以及有计划进行的手术。这是一项基于患者记录的回顾性描述性研究。在统计分析中，Fisher精确检验和Mann-Whitney U检验用于分析二分变量和连续/有序变量。
92例患者中，78%由EMS送往医院。最常见的症状是疼痛（94%）。89%的患者疼痛剧烈或非常剧烈，这与是否使用EMS无关。使用EMS的患者中只有47%使用了麻醉性镇痛药缓解疼痛。入院时只有12%的患者无痛。EMS工作人员仅在17%的病例中报告怀疑为主动脉夹层。调度中心（31%）和EMS临床医生（52%）最常见的初步诊断是胸痛或心绞痛。总体而言，79%的患者出院时存活（使用EMS者为75%，未使用者为95%）。
在哥德堡因主动脉夹层住院的患者中，78%使用了EMS。尽管大多数患者疼痛严重，但不到一半的患者使用了麻醉性镇痛药，入院时只有12%的患者无痛。EMS工作人员报告怀疑为主动脉夹层的患者不到五分之一。
