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急性主动脉夹层和胸主动脉破裂的管理

Management of acute aortic dissection and thoracic aortic rupture.

作者信息

Fukui Toshihiro

机构信息

Department of Cardiovascular Surgery, Kumamoto University Hospital, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-5663 Japan.

出版信息

J Intensive Care. 2018 Mar 1;6:15. doi: 10.1186/s40560-018-0287-7. eCollection 2018.

Abstract

BACKGROUND

Both acute aortic dissection and ruptured aortic aneurysm are leading causes of death in cardiovascular disease. These life-threatening conditions have recently been categorized as acute aortic syndrome. This review describes the etiology, clinical presentation, and therapeutic options for acute aortic syndrome including acute aortic dissection and ruptured aortic aneurysm.

MAIN BODY

Several diagnostic tools for detecting these critical conditions have been developed including computed tomography, ultrasonography, magnetic resonance imaging, and laboratory tests. Early and accurate diagnosis is most important to determine appropriate treatment. Initial treatment for these conditions should be aimed at controlling pain and the hemodynamic state with further treatment based on the imaging diagnosis and hematological assessment. Surgical outcomes after acute aortic syndrome are improving gradually; however, mortality remains high. Recently, thoracic endovascular aortic repair has become an alternative technique to treat complicated type B aortic dissection. Rapid treatment after early diagnosis is essential to save patients' lives.

CONCLUSIONS

Continuous advances in imaging and treatment technologies are improving short- and long-term outcomes in patients with acute aortic syndrome. Knowledge and interest in intensive care medicine in this area are contributing to improved outcomes, and further research into this life-threatening disease will lead to improvements in diagnosis and management.

摘要

背景

急性主动脉夹层和主动脉瘤破裂均为心血管疾病的主要死因。这些危及生命的病症最近被归类为急性主动脉综合征。本综述描述了急性主动脉综合征(包括急性主动脉夹层和主动脉瘤破裂)的病因、临床表现及治疗选择。

正文

已开发出多种用于检测这些危急病症的诊断工具,包括计算机断层扫描、超声检查、磁共振成像及实验室检查。早期准确诊断对于确定恰当治疗最为重要。这些病症的初始治疗应旨在控制疼痛和血流动力学状态,并根据影像学诊断和血液学评估进行进一步治疗。急性主动脉综合征后的手术效果正在逐步改善;然而,死亡率仍然很高。最近,胸主动脉腔内修复术已成为治疗复杂性B型主动脉夹层的一种替代技术。早期诊断后迅速治疗对于挽救患者生命至关重要。

结论

成像和治疗技术的不断进步正在改善急性主动脉综合征患者的短期和长期预后。该领域对重症医学的了解和关注有助于改善预后,对这种危及生命疾病的进一步研究将带来诊断和管理方面的改善。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/62bf/5831732/e3852da8ee1a/40560_2018_287_Fig1_HTML.jpg

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