钝性胸主动脉损伤的诊治进展

doi:10.6040/j.issn.1671-7554.0.2024.0319

摘要/Abstract

摘要： 钝性胸主动脉损伤(blunt thoracic aortic injury, BTAI)是创伤患者发病和死亡的主要原因,有80%~90%的患者在事故现场立即死亡。尽管近年来急性BTAI的检测和治疗取得了快速进展,但其致死率仍然很高,24 h院内死亡率达到15%~40%。主动脉损伤的机制与物理撞击和血流动力学的急剧改变有关,所以对于最初损伤中幸存下来的患者,及时维持血流动力学稳定可能避免损伤加重。对于能够到达医院治疗的患者,快速检测和及时合理干预至关重要。CT血管成像可以快速、准确评估主动脉损伤程度,指导制定合理的治疗措施。根据最新指南,Ⅰ级、Ⅲ级、Ⅳ级患者治疗时机及方式已明确,仅BTAI合并高危影像特征Ⅱ级患者修复时机的选择仍存在一定的争议。主动脉腔内修复术临床成功率高而并发症发生率低,已成为BTAI手术治疗的首选方式,但仍存在一些不可避免的焦点问题。本文主要对BTAI的损伤机制、临床表现和影像学诊断、治疗的最新进展进行综述。

关键词: 创伤, 主动脉损伤, 假性动脉瘤, 胸主动脉腔内修复术, 开放性修复

Abstract: Blunt thoracic aortic injury(BTAI)is the major cause of morbidity and mortality in trauma patients, with 80%-90% of patients dying immediately at the scene of the accident. Despite rapid advances in the detection and treatment of acute BTAI in recent years, the mortality rate remains high, with a mortality rate of 15%-40% of in-hospital deaths within 24 hours. The mechanism of aortic injury is related to physical impact and drastic changes in hemodynamics. For patients who survive the initial injury, maintaining hemodynamic stability in time may prevent injury exacerbation. For patients who can reach the hospital, rapid detection and timely and reasonable intervention are crucial. CT angiography can quickly and accurately evaluate the degree of aortic injury and guide the reasonable treatment measures. According to the latest guidelines, the time and method of treatment for grade Ⅰ, Ⅲ and Ⅳ patients have been clearly defined. But repair time in grade Ⅱ patients with BTAI combined with high-risk imaging features is still controversial. Thoracic endovascular aortic repair due to high clinical success rate and low complication rate has become the preferred method for BTAI, but there are still some unavoidable focal problems. This article mainly reviewed the injury mechanism, clinical manifestations, imaging diagnosis and treatment of BTAI.

Key words: Trauma, Aortic injury, Pseudoaneurysm, Thoracic endovascular aortic repair, Open repair

中图分类号:

R543

杨建平,管圣,方青波,慈红波,戈小虎. 钝性胸主动脉损伤的诊治进展[J]. 山东大学学报 (医学版), 2024, 62(9): 36-41.

YANG Jianping, GUAN Sheng, FANG Qingbo, CI Hongbo, GE Xiaohu. Advances in diagnosis and treatment of blunt thoracic aortic injury[J]. Journal of Shandong University (Health Sciences), 2024, 62(9): 36-41.

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