无痛性B型主动脉夹层：来自急性主动脉夹层国际注册研究的见解
Painless Type B Aortic Dissection: Insights From the International Registry of Acute Aortic Dissection.
作者信息
Tolenaar Jip L, Hutchison Stuart J, Montgomery Dan, O'Gara Patrick, Fattori Rosella, Pyeritz Reed E, Pape Linda, Suzuki Toru, Evangelista Arturo, Moll Frans L, Rampoldi Vincenzo, Isselbacher Eric M, Nienaber Cristoph A, Eagle Kim A, Trimarchi Santi
机构信息
Department of Cardiovascular Surgery, Policlinico San Donato IRCCS, Milan, Italy;
St. Michael's Hospital, Toronto, Ontario, Canada;
出版信息
Aorta (Stamford). 2013 Jul 1;1(2):96-101. doi: 10.12945/j.aorta.2013.13-014. eCollection 2013 Jul.
INTRODUCTION
The classical presentation of a patient with Type B acute aortic dissection (TBAAD) is characterized by severe chest, back, or abdominal pain, ripping or tearing in nature. However, some patients present with painless acute aortic dissection, which can lead to a delay in diagnosis and treatment. We utilized the International Registry on Acute Aortic Dissections (IRAD) database to study these patients.
METHODS
We analyzed 43 painless TBAAD patients enrolled in the database between January 1996 and July 2012. The differences in presentation, diagnostics, management, and outcome were compared with patients presenting with painful TBAAD.
RESULTS
Among the 1162 TBAAD patients enrolled in IRAD, 43 patients presented with painless TBAAD (3.7%). The mean age of patients with painless TBAAD was significantly higher than normal TBAAD patients (69.2 versus 63.3 years, P = 0.020). The presence of atherosclerosis (46.4% versus 30.1%, P = 0.022), diabetes (17.9% versus 7.5%; P = 0.018), and other aortic diseases (8.6% versus 2.3%, P= 0.051), such as prior aortic aneurysm (31% versus 18.8% P = 0.049) was more common in these patients. Median delay time between presentation and diagnosis was longer in painless patients (median 34.0 versus 19.0 hours; P = 0.006). Dissection of iatrogenic origin (19.5% versus 1.3%; P < 0.001) was significantly more frequent in the painless group. The in-hospital mortality was 18.6% in the painless group, compared with an in-hospital mortality of 9.9% in the control group (P = 0.063).
CONCLUSION
Painless TBAAD is a relatively rare presentation (3.7%) of aortic dissection, and is often associated with a history of atherosclerosis, diabetes, prior aortic disease including aortic aneurysm, and an iatrogenic origin. We observed a trend for increased in-hospital mortality in painless TBAAD patients, which may be the result of a delay in diagnosis and management. Therefore, physicians should be aware of this relative rare presentation of TBAAD.
引言
B型急性主动脉夹层（TBAAD）患者的典型表现为严重的胸痛、背痛或腹痛，性质为撕裂样或刀割样。然而，一些患者表现为无痛性急性主动脉夹层，这可能导致诊断和治疗延迟。我们利用国际急性主动脉夹层注册数据库（IRAD）研究这些患者。
方法
我们分析了1996年1月至2012年7月期间纳入该数据库的43例无痛性TBAAD患者。将其在临床表现、诊断、治疗及预后方面的差异与有疼痛症状的TBAAD患者进行比较。
结果
在IRAD登记的1162例TBAAD患者中，43例表现为无痛性TBAAD（3.7%）。无痛性TBAAD患者的平均年龄显著高于有疼痛症状的TBAAD患者（69.2岁对63.3岁，P = 0.020）。这些患者中动脉粥样硬化（46.4%对30.1%，P = 0.022）、糖尿病（17.9%对7.5%；P = 0.018）以及其他主动脉疾病（8.6%对2.3%，P = 0.051），如既往主动脉瘤（31%对18.8%，P = 0.049）更为常见。无痛性患者从出现症状到诊断的中位延迟时间更长（中位时间34.0小时对19.0小时；P = 0.006）。无痛性组医源性起源的夹层（19.5%对1.3%；P < 0.001）明显更常见。无痛性组的院内死亡率为18.6%，而对照组为9.9%（P = 0.063）。
结论
无痛性TBAAD是主动脉夹层相对少见的表现形式（3.7%），常与动脉粥样硬化、糖尿病病史、包括主动脉瘤在内的既往主动脉疾病以及医源性起源相关。我们观察到无痛性TBAAD患者院内死亡率有升高趋势，这可能是诊断和治疗延迟所致。因此，医生应了解TBAAD这种相对少见的表现形式。
Zotero 插件