这个病人有急性胸前大动脉解剖吗?
1Department of Medicine, Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115, USA. mklompas@partners.org
JAMA
|May 1, 2002
概括
诊断急性胸前大动脉解剖是具有挑战性的. 虽然突然强烈的疼痛和特定的身体检查结果,如脉冲缺陷增加怀疑,他们并不总是存在,使临床诊断困难.
科学领域:
- 心脏病学 心脏病学
- 放射学 放射学是指放射学
- 紧急医疗 紧急医疗
背景情况:
- 急性胸前大动脉剖析是一种危及生命的疾病,具有诊断挑战.
- 延迟对大动脉解剖进行诊断会增加发病率和死亡率.
研究的目的:
- 评估临床病史的诊断准确性,体检和急性胸前动脉解剖的胸部放射.
- 确定有助于诊断胸前大动脉解剖的关键临床指标.
主要方法:
- 使用MEDLINE进行了对1966年至2000年的英语语言研究的综合文献综述.
- 包括的研究重点是连续患者的临床发现,确认胸前大动脉剖析.
- 根据预先定义的质量和纳入标准,选择了21项相关研究.
主要成果:
- 突发严重的疼痛 (90%的灵敏度) 和突然发作 (84%的灵敏度) 在胸前大动脉剖析中很常见.
- 像脉冲缺陷 (LR 5.7) 和神经缺陷 (LR 6.6-33.0) 等物理发现显著增加了怀疑.
- 一个正常的胸部X射线图 (负LR 0.3) 或缺乏突然疼痛降低了剖析的概率.
结论:
- 脉冲缺陷,神经缺陷和突然严重的疼痛是急性胸前大动脉剖析的关键指标.
- 正常的胸部X射线图或缺乏突然疼痛可以降低剖析的可能性.
- 仅通过临床检查就不足以排除大动脉解剖,因为其敏感度低,错误诊断的风险高.
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