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急性大动脉解剖和内腔血瘤:一个系统的审查
Firas F Mussa1, Joshua D Horton2, Rameen Moridzadeh3
1Division of Vascular Surgery, Department of Surgery, Columbia University Medical Center, New York, New York.
JAMA
|August 18, 2016
概括
由于急性大动脉综合征的高死亡率,需要及时诊断和治疗. 像CT和MRI这样的成像是关键,对于上升大动脉病例通常需要手术,而内血管修复则对下降大动脉AAS有希望.
科学领域:
- 心血管医学
- 诊断成像
- 外科创新
背景情况:
- 急性大动脉综合征 (AAS) 是一种危及生命的疾病,涉及大动脉壁,通常呈现为严重的胸痛和高血压.
- AAS包括主动脉解剖和内壁血瘤,并可能导致输血受损和动脉瘤形成.
- 尽管这种情况很罕见 (每10万患者年3.5-6.0),但由于经常需要紧急手术,迅速诊断至关重要.
研究的目的:
- 对有关急性大动脉综合征的诊断和治疗的现有证据进行系统审查.
- 综合临床试验和观察性研究的发现,以告知临床实践.
主要方法:
- 搜索了MEDLINE,EMBASE和Cochrane对照试验登记册的AAS诊断和治疗研究 (1994年6月至2016年1月).
- 包括至少10名患者的临床试验和前性观察研究.
- 审查了82项涉及57,311名患者的研究,包括2项随机临床试验和80项观察性研究.
主要成果:
- 胸部或背部疼痛 (61. 6% - 84. 8%) 和高血压 (45% - 100%) 是60至70岁患者的常见症状,主要是男性.
- 在CT (100%),MRI (95% - 100%) 和透食管心声学 (86% - 100%) 中报告了高诊断灵敏度.
- 由于A型AAS的高死亡率 (26% - 58%) 建议进行开放性手术,而内血管修复在一项RCT中显示了B型AAS的优异结果.
结论:
- 鉴于AAS的高死亡率,特别是在急性胸痛/背痛和高血压患者中,迅速识别和诊断至关重要.
- 电脑图像扫描,核磁共振和透食心电图像是AAS的可靠诊断方式.
- 虽然对A型AAS进行开放性手术,对B型AAS进行内血管修复,但由于缺乏随机试验,证据是有限的.
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