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相關文獻
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頁籤選單縮合
題 名 | Acute Manifestation and Clinical Recognition of Aortic Dissection=主動脈剝離的急性表徵與臨床確認 |
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作 者 | 張洵維; 王立敏; 顏鴻章; 賴曉亭; 李建賢; | 書刊名 | 中華民國急診醫學會醫誌 |
卷 期 | 1:2 1999.08[民88.08] |
頁 次 | 頁123-132 |
分類號 | 416.263 |
關鍵詞 | 主動脈剝離; 臨床表徵; 急診部; Aortic dissection; Clinical features; Emergency department; |
語 文 | 英文(English) |
中文摘要 | Acute aortic dissection is a catastrophic condition with protean manifestations. Its diagnosis is often delayed or missed in the emergency department, despite recent advances in noninvasive diagnostic technology. To promote improvement n the rapid recognition of aortic dissection, we reviewed 272 confirmed cases of aortic dissection from February 1979 through March 1998. Of the 272 patients, 224 patients (82%) had acute and 48 patients (18%) had chronic aortic dissection. Hypertension was the most common predisposing factor (70% of all patients) and was significantly more common in type B aortic dissection. The most common initial complaint was an acute onset of servere chest pain (78%). About 19% of patients had initial complaints other than pain or were asymptomatic. Less common manifestatioins included congestive heart failure, cerebrovascular accident, shock, syncope, and paraplegia. Patients with type A aortic dissection were younger and had a significantly higher incidence of anterior chest pain, neurologic deficits, and aortic regurgitation. Despite a more widespread appreciation of the disease and advances in diagnostic technology, the single most important factor in making the diagnosis is still a high index of suspicion by the physician. Aortic dissection should always be considered in the differential diagnosis in a patient presenting with hypertension, unexplained syncope, stroke, congestive heart failure, acute arterial occlusion, or an abnormal aortic contour on chest roentgenography, even in the absence of chest pain. |
英文摘要 | 急性主動脈剝離式一種臨床表現多樣化且危及生命的急症。雖然最近在非侵襲性診斷工具上有新的進展,但是仍然常被延誤或誤診。為了提升迅速診斷的能力,我們回溯性地回顧臺北榮民總醫院從西元1979年2月到西元1998年3月間272位主動脈剝離病人的臨床表徵。研究結果顯示,在這272位主動脈剝離病人當中,224位(82%)是急性主動脈剝離,48位(48%)是慢性主動脈剝離。高血壓是最常見的危險因子,占所有病人的百分之七十,而且在B型主動脈剝離病人中較常見。急性胸痛是最常見的主訴,占所有病人的百分之七十八。相反地,有百分之十九的病人一開始並不是以痛來表現或甚至沒有症狀。有些病人是以較少見的暈厥、充血性心衰竭、腦血管疾病、休克和半身不遂來表現。A型主動脈剝離病人的罹病年齡較輕,且有較高的比例發生前胸痛、神經學症狀和主動脈瓣逆流。雖然最近在非侵襲性診斷工具上有新的進步,要早期診斷此病最重要的關鍵仍有賴醫師之高度警覺心。當遇到一個病人有高血壓,無法解釋的暈厥,腦中風,充血性心衰竭,急性動脈阻塞,或是在胸部X光上主動脈的輪廓有異常等情形,即使病人沒有胸痛,均須將主動脈剝離列入鑑別診斷當中 。 |
本系統中英文摘要資訊取自各篇刊載內容。