主动脉夹层动脉瘤主动脉夹层分离精选课件

l主动脉夹层动脉瘤 l主动脉夹层分离 病因 l高血压 2/3 年龄40 l马凡氏综合征 青壮年 家族史 Marfan综合征 l遗传学特征 微纤维原基因突变 （15q21.1） l骨骼异常 臂指间距超过身长，下部量 l 超过上部量，蜘蛛脚。 l心血管改变 AAO扩张45MM，AR l眼部改变 晶状体向上脱位，角膜扁平 l皮肤表现 胸腹臀膨胀性萎缩纹 l肺部表现 脓胸、气胸（结缔组织活力缺失 ） 病理基础 l主动脉中层胶原和弹力纤维 病变 内膜裂口 l血液流入中层 夹层扩 l大 出现真腔假腔 l血栓，夹层破裂 DeBeKey分型 lI型 夹层起始于升主动脉并延伸到 降主动脉。 lII型 夹层局限于升主动脉。 lIII型 夹层起始于降主动脉，并向远 心端延伸。 超声心动图表现 l主动脉内径增宽，多大于40mm。 l剥脱的内膜将主动脉分为真腔和假腔， 真腔多狭小，假腔一般较大。 l剥脱的内膜在真假腔间摆动，应注意寻 找破裂口的位置。 l夹层累及主动脉瓣时，引起主动脉瓣返 流，左心室扩大 临床价值与存在问题 l超声 床旁进行，简便安全，无创 l 敏感性 特异性 lECHO 97% 100% lANGIO 78% 95% lCT 80% 100% lMRI l区别真腔与假腔 l识别入口和再入口 l判断主动脉夹层病变范围及类型 l判断预后 l判断假腔中有无血栓形成 l术后随访 zP*csIZ5lBS-evL!8oEV1hyO&brHY4kBR)duK#7nDU0gxN%aqGX3jAQ(dtJ#6mCT+fw$9pFW2iyP*bsIY5lBS-evL!8oEV1hyO&arHX4kAR)duK#7nDU0gxN%aqGW3jzQ(ctJZ6mCT+fwM$9pFW2iyP*bsIY5lBS-evL!8oEV1hyO&arHX4kAR)duK#7nDU0gxN%aqGX3jzQ(ctJZ6mCT+fwM$9pFW2izP*bsIY5lBS-evL!8oEV1hyO&brHX4kAR)duK#7nD0gwN%9qGW3jzQ(ctJZ6mCT+fvM$8pFV2iyP*bsIY5lBS-evL!8oEU1hxO&arHX4kAR)duK#7nDU0gwN%9qGW3jzQ(ctJZ6mCT+fwM$8pFV2iyP*bsIY5lBS- 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