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目的:探讨急性主动脉夹层(AAD)继发急性心肌梗死(AMI)的临床特点及治疗方案。方法:回顾性分析8例ADD合并AMI患者的临床表现、相关辅助检查资料。结果:本组患者均以胸痛为首发症状,伴有心电图ST-T改变,确诊ADD前均首诊为AMI,1例行急诊冠状动脉造影时确诊,4例行大动脉CT血管造影(CTA)确诊,1例行心脏彩超(UCG)确诊,2例行320排CTA确诊;确诊后均转入心胸外科,手术治疗4例,保守治疗4例,治愈6例,死亡2例。结论:AAD累及冠状动脉和(或)相关因素导致心肌氧供需平衡可继发AMI,临床症状及心电图、心肌酶谱、心肌标志物与原发性AMI不易鉴别,及其容易导致误诊及不恰当治疗,对首诊为AMI的患者,应警惕合并ADD的可能,并完善相关辅助检查予以明确,防止误诊发生。
Objective: To investigate the clinical features and treatment of acute myocardial infarction (AMI) with acute aortic dissection (AAD). Methods: Retrospective analysis of 8 cases of ADD with AMI patients with clinical manifestations, related auxiliary examination data. Results: The patients had chest pain as the first symptom, ST-T change of electrocardiogram, first diagnosis of AMI before diagnosis of ADD, diagnosis of emergency coronary angiography, and diagnosis of major artery CT angiography (CTA) in 4 cases , One was diagnosed by UCG, and the other two were diagnosed by CTA with 320 rows. After diagnosis, all patients were transferred to cardiothoracic surgery. Four cases were treated by surgery and four cases were treated conservatively. Six cases were cured and two died. Conclusions: AAD with coronary artery involvement and / or related factors may lead to myocardial oxygen balance and secondary to AMI. Clinical symptoms and ECG, myocardial zymogram, myocardial markers and primary AMI are not easily identified, and they are easily misdiagnosed and inappropriate Treatment, the first diagnosis of AMI patients should be wary of the possibility of the merger ADD, and improve the relevant auxiliary examination to be clear, to prevent misdiagnosis.