Analysis Of Clinical Records Of 68 Patients With Aortic Dissection

Objective To explore the risk factor,clinical features, misdiagnosis,examination methords of aortic dissection(AD)and treatment of aortic dissection(AD).Methods Retrospective review of the clinical records of 68 AD patients from the Janurary in 2001 to December in 2007 had been done.Results(1)The 67.8%of all patients had no obvious motivation,82.4%had history of hypertension.(2)There are 92.7% patients had pain as initial symptom,32.4%had shock,82.4%had hypertension when onset or on admission.(3)The incidence of chest pain in DebakeyⅠandⅡpatients(68.4%)were obviously higher than DebakeyⅢcases(2%)(P＜0.01),and the incidences of painful shoulder and back(15.8%),waist,abdomen and melosalgia(10.5%)were obviously lower than Debakey III(56.7%,46.7%)(P＜0.01).(4)64.7%cases had abnormal EKG appearance,most of them were LVH with myocardial strain or non-myocardial strain(38.6%),27.3%had abnormal ST-T.(5)The separation of intimae was the most reliable criteria to diagnosis true lumen from false lumen. The diagnostic rate of AD by TTE,CTA,MRI,DSA was 22%,98.3%,100% and 100%.(6)There are 48 patients(70%)were treated with medical therapy alone,75%were treated through a infusion of nitroprusside by intervenous drop or by vein pump,83.3%used beta blocker to descend heart rate,85.4% used temperantia and anodyne,the hospitalized improvement rate of AD patients with medical therapy alone was 93.8%,The hospital mortality was 6.3%.(7)10 patients were treated by artificial vessel replacement operations, 7 cases was cured and 3 was dead.(8)10 patients(14.7%)were performed endovascular exclusion(EVE),there were 12 Stent-graft had been implanted,9 cases were mended,1 cases died after operation.Conclusion The AD patiens generally have hypertension,the main symptoms is pains,the area of pain related to AD type,the ECG changes of AD patients mostly have no specificity,CTA,MRI and DSA have a high diagnosis rate in the AD.Medicine is still the main treatment methods for AD,the level of surgical and EVE treatment still needs to be improved.