文档介绍：罗建方主任医师
广东省人民医院
广东省心血管病研究所
•英国国王乔治二世,是个身材魁梧的人。
他两眼湛蓝,肤色绯红,鼻子略大。
•他长期仇恨父王乔治一世。
•母亲出轨,爱上了龙骑兵上校。
•乔治一世的父王,不肯授予他任何卑微
的官职。
•长期的压抑使他变得脾气暴躁,行事傲
慢,他把身边所有的男人和女人,都看
作自己一时高兴愿踢打就踢打、愿亲吻
就亲吻的奴隶。
e II, King of England(1683-1760)
•战功颇丰!
•某个11月的早上,他6点起床如常, 像
往日一样喝了一杯咖啡.
• 7点一刻,他走进了厕所. 他的德国贴
身男仆在门口守候
•一声嘲杂
•当冲进去时候,发现这位伟大的国王
已经死了。
…the pericardium was found distended with a
quantity of coagulated blood, nearly a pint . . .;
the whole heart was pressed as to
prevent any blood contained in the veins from
being forced into the auricles; therefore the
ventricles were found absolutely void of
blood . . .; and in the trunk of the aorta we
found a transverse fissure on its inner side,
about an inch and a half long, through which
some blood had recently passed under its
external coat and formed an elevated
ecchymosis floor.
• 1819, René Laennec首次使用
“夹层动脉瘤”(dissecting
aneurysm).
René Laennec 听诊器发明人
• Maunoir (in 1802) had
already proposed the correct
term “aortic dissection
• he could not match
Laennec’s “star power”
and notoriety
胸主动脉腔内高速、高压血流从动
脉内膜撕裂处进入主动脉壁内,使
主动脉中膜与外膜分离(甚或一并
撕破外膜而破裂),外膜继而扩张膨
出而形成夹层动脉瘤
一种临床危急重症!
. 发病率 / 十万人/年(尸检)
为破裂腹主动脉瘤的2-3倍
. 死亡率 / 十万/年(美国)
. 男女之比 3 :1
. 发病年龄多为 50岁以上
Svensjo S, Bengtsson H, Bergqvist D. Thoracic and thoracoabdominal aortic aneurysm
and dissection: an investigation based on autopsy. Br J ;83:68-71.
•高血压和动脉粥样硬化
•特发性主动脉中层退性性变
•遗传性疾病
马凡综合征、Ehlers-Danlos综合症、Tuner综合征
•先天性主动脉畸形
先天性主动脉瓣二瓣化畸形、狭窄和主动脉缩窄
•创伤
主动脉的钝性创伤、心导管检查、主动脉球囊反搏、主动脉
钳夹阻断等
•主动脉壁的炎症反应和医源性感染
2002:160 M, 2009:200 M, 31% ↑ vs 1991
20
18
(%) 16
14
12
10
8
6
4
Hypertension Population Hypertension 2
0
1959 1980 1991 2002
2005 China HP Guidline (Year)