Objective To investigate the values of the D-dimer and hypersensitive C-reactive protein (hs-CRP) in the diagnosis of type B aortic dissection. Methods Forty-two patients of type B aortic dissection with chest pain were en-rolled to our hospital from June 2013 to June 2015, which were divided into typical type B aortic dissection group (typical group, n=30) and atypical aortic dissection group (atypical group, n=12) according to the examination results at admission. The levels of D-dimer and hs-CRP were determined and analyzed at the onset of 12 hours, 24 hours, 72 hours, two weeks, and the correlations between levels of D-dimer, hs-CRP and type B aortic dissection were analyzed. Results D-dimer and hs-CRP levels in patients with aortic dissection had increased to varying degrees. The levels of serum D-dimer at 12 hours, 24 hours, 72 hours and two weeks after onset were (875.0±190.0) ng/mL, (1,021.0±386.0) ng/mL, (2,056.0±912.0) ng/mL, (6,780.0 ± 1163.0) ng/mL in typical group and (926.0 ± 108.0) ng/mL, (989.0 ± 320.0) ng/mL, (1,478.0 ± 825.0) ng/mL, (3,568.0±1,558.0) ng/mL in atypical group. The levels of hs-CRP at 12 hours, 24 hours, 72 hours and two weeks were (25.8 ± 11.4) mg/L, (60.9 ± 9.7) mg/L, (110.0 ± 27.5) mg/L, (86.4 ± 21.8) mg/L in typical group and (29.1 ± 14.5) mg/L, (44.7 ± 11.2) mg/L, (103.2 ± 25.4) mg/L, (79.5 ± 36.3) mg/L in atypical group. The difference between typical group and atypical group in the levels of D-dimer were significant (P<0.05), and there were no statistically significant differences in the levels of hs-CRP between the two groups (P>0.05). Conclusion D-dimer and hs-CRP are helpful in the diagno-sis of aortic dissection, and D-dimer contributes to the differential diagnosis of type B aortic dissection.

目的 总结心脏外科手术后胸骨哆开的外科治疗经验.方法 回顾性分析2011年1月-2014年1月收治的7例心脏外科手术后出现胸骨哆开患者的临床资料,其中男4例,女3例;年龄35～72岁,平均(52.5±13.4)岁.冠状动脉旁路移植术后2例,心脏瓣膜置换术后4例,孙氏手术后1例.彻底清创,剔除坏死胸骨,全部拔除原胸骨钢丝,清除胸骨后感染组织,聚维酮碘纱布浸泡并反复冲洗,充分游离切口两侧组织,乃至分离至胸大肌内侧头使间断缝合时组织无明显张力,放置皮片及负压引流管以充分引流.结果 7例患者均取得良好的治疗效果.术后随访6个月,所有患者均胸骨固定,无明显胸廓畸形,未发现胸骨慢性迁延性感染.结论 对心脏外科术后出现胸骨哆开的患者应积极行手术清创,牢固稳固胸骨.切口血液供应丰富及全身状态改善对患者康复尤为关键.

Objective To study the diagnosis and treatment measures, misdiagnosis cause and preventive measures of aortic dissection. Methods Clinical data of one patient misdiagnosed with aortic dissection was retrospectively analyzed, and related literature was reviewed. Results A patient suffering from severe abdominal pain 6 for hours was admitted to our hospi-tal from a local hospital, where he had been misdiagnosed as acute pancreatitis and failed to respond to treatment there. The patient was confirmed as having acute aortic dissection by aortic computer tomography angiography. Under general anesthesia, the patient underwent thoracic endovascular aortic repair ( TEVAR) , and the celiac trunk dissection was confirmed. This pa-tient fully recovered after TEVAR, and was discharged from hospital seven days later. He was followed up for one year with good prognosis. Conclusion Atypical clinical performance of aortic dissection may be the cause of misdiagnosis. To avoid or reduce misdiagnosis and mistreatment, clinicians should enhance awareness of aortic dissection, carry out intensive research of the main points of diagnosis with the help of imagining examination.

主动脉夹层是指由于各种原因造成血管内膜局部撕裂，在动脉内形成真、假两腔，从而导致一系列包括胸背部撕裂样疼痛及累及器官缺血在内的临床表现。如果不进行恰当和及时的治疗，患者可能出现猝死。传统治疗方式为开胸人造血管置换术，但围手术期死亡率及并发症发生率也非常高。车祸及减速伤引起患者胸主动脉内膜撕裂导致的主动脉夹层较为少见，而新近开展的主动脉夹层腔内修复术（thoracic endovascular aortic repair ， TEVAR）是治疗该种疾病的有效方法［1］。2014年1—6月我院共收治该类患者2例，均得到及时诊断并采用该技术进行手术治疗，取得良好远期疗效。现报告如下。