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目的探讨避免大范围主动脉夹层并急性冠状动脉综合征误诊的体会。方法回顾性分析1例大范围主动脉夹层并急性冠状动脉综合征的诊治经过。结果本例因反复心前区疼痛入院,经完善心电图、心肌酶等检查诊断为冠心病、急性冠状动脉综合征、高血压病3级(极高危组)。给予止痛、抗凝、抗血小板聚集、稳定斑块、改善循环及对症支持治疗,疗效不佳。进一步行X线胸片、心脏彩超及主动脉CT血管造影检查,明确诊断为主动脉夹层(DeBakeyⅠ型)。患者病情严重,入院次日抢救无效死亡。结论对于大范围主动脉夹层并急性冠状动脉综合征者,重视四肢血压测定、积极完善相关检查、客观分析各项检查结果有助于明确诊断,减少误诊。
Objective To explore the experience of avoiding a wide range of aortic dissection and misdiagnosis of acute coronary syndrome. Methods One case of extensive aortic dissection and diagnosis and treatment of acute coronary syndrome were retrospectively analyzed. Results In this case, pain was admitted to the precordial area and was diagnosed as coronary heart disease, acute coronary syndrome and hypertensive grade 3 (very high risk group) by the improved electrocardiogram and myocardial enzymes. Give painkillers, anticoagulants, anti-platelet aggregation, stable plaque, improve circulation and symptomatic supportive care, poor efficacy. Further line X-ray, echocardiography and aortic CT angiography, a clear diagnosis of aortic dissection (DeBakey Ⅰ type). The patient was seriously ill and died of ineffectiveness on the next day of admission. Conclusion For a wide range of patients with aortic dissection and acute coronary syndrome, emphasis on blood pressure measurement of the limbs, and actively improve the relevant tests, objective analysis of the test results help to confirm the diagnosis and reduce misdiagnosis.