Wooley C F, Sparks E H, Boudoulas H
Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus 43210, USA.
Prog Cardiovasc Dis. 1998 May-Jun;40(6):563-89. doi: 10.1016/s0033-0620(98)80004-2.
With the exception of the pain of acute aortic dissection, the thoracic aorta is not usually considered as a pain-producing organ. However, nineteenth century clinicians considered the aorta as a source of cardiovascular pain in the presence of autopsy-documented inflammatory aortitis, aortic aneurysms, and arterial hypertension, whereas early in the twentieth century, aortic pain reactions were elicited in experimental studies involving distension of the ascending aorta or the application of stimulating substances to the outer surface of the aorta. More recently, increased attention to aortic elastic properties, and to aortic vascular biology at the molecular level refocused interest on the many facets of aortic function beyond that of a simple conduit. The recognition of pain of thoracic aortic origin now extends to patients with progressive aortic syndromes such as aortic intramural hematoma, aortic intimal tears, aortic penetrating ulcers, aortic root dilatation without dissection in connective tissue disorders, inflammatory aortopathies, and abnormalities of aortic distensibility. The occurrence of pain during balloon inflation at balloon angioplasty of aortic coarctation, which disappears immediately after deflation, is the modern equivalent of the early experimental studies. The authors present a consideration of thoracic aortic pain in light of contemporary concepts in cardiovascular medicine with roots in the rich historical reservoir of information about aortic function and disease.
除急性主动脉夹层的疼痛外，胸主动脉通常不被视为产生疼痛的器官。然而，19世纪的临床医生在尸检证实存在炎性主动脉炎、主动脉瘤和动脉高血压时，认为主动脉是心血管疼痛的来源，而在20世纪早期，在涉及升主动脉扩张或在主动脉外表面应用刺激物质的实验研究中引发了主动脉疼痛反应。最近，对主动脉弹性特性以及分子水平上的主动脉血管生物学的更多关注，使人们重新关注主动脉功能的诸多方面，而不仅仅是其作为简单管道的功能。现在，胸主动脉源性疼痛的认识已扩展到患有进行性主动脉综合征的患者，如主动脉壁内血肿、主动脉内膜撕裂、主动脉穿透性溃疡、结缔组织疾病中无夹层的主动脉根部扩张、炎性主动脉病变以及主动脉扩张性异常。在主动脉缩窄球囊血管成形术球囊充气期间出现的疼痛，在放气后立即消失，这相当于早期的实验研究。作者根据心血管医学的当代概念，结合有关主动脉功能和疾病的丰富历史信息库，对胸主动脉疼痛进行了探讨。
