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主动脉瘤破裂:
一种可能导致心脏性猝死的医疗紧急情况
心源性猝死是指因心脏功能丧失或心源性骤停而导致的突发性、意外性死亡。一半以上的心脏病死亡是由心脏猝死引起的。心源性猝死最常发生于没有任何征兆和症状的成人。意外死亡的发生往往是由于未被发现的心脏缺陷或被忽视的心脏异常。通常导致心源性猝死的特定情况是急性心肌梗死、急性心力衰竭和冠心病。然而,被称为“主动脉瘤破裂”的紧急情况也是导致心源性猝死的主要原因之一。
主
动
脉
瘤
主
动
脉
瘤
主动脉瘤是主动脉壁的突起或扩张,主动脉是将血液从心脏输送到身体的主要血管。主动脉壁扩张是由主动脉壁某些部位的虚弱或退化引起的。主动脉瘤包括腹主动脉瘤(在腹部)和胸主动脉瘤(在胸腔)。动脉瘤可能会变大,主动脉壁无法再延伸。在这一点上,动脉瘤有破裂的风险,并可能出现致命的情况。如果破裂的主动脉瘤不能及时准确诊断和有效治疗,就会引起危及生命的内出血,从而增加猝死的几率。
“美国的临床资料表明,破裂的动脉瘤通常是在法医调查猝死患者时被发现。病理结果显示主动脉壁破裂。高达50%的动脉瘤破裂患者往往在得到医疗救助前就已死亡。”
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危
险
因
素
01
发生主动脉瘤破裂
的危险因素
动脉瘤最常发生在40岁及60-70岁以上的人身上。然而,在较年轻的人群中发病率也在增高。男性比女性更容易患上腹主动脉瘤。有很多因素对动脉瘤的形成起着重要作用,包括:
·高血压(hypertension)。高血压会损害和削弱主动脉壁。
·高胆固醇(高胆固醇血症)。高胆固醇会导致动脉粥样硬化斑块在血管内壁形成。
·高血糖(糖尿病)
·生活习惯,例如吸烟、肥胖或超重、压力过大等。
·基因改变可以削弱主动脉壁。
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征
兆
症
状
02
主动脉瘤破裂的
征兆和症状
主动脉瘤的危险是没有预示疾病发展的征兆和症状。当出现症状时,它从最内层到中间层,最终到将血管与周围组织连接在一起的最外层出现破裂。动脉瘤破裂会引起血液循环不规律。加重症状包括突然出现强烈的,持续的胸痛,这种疼痛会向背部或腹部放射,可描述为撕裂感。如果出现该症状,必须立即寻求医疗护理,以便得到适当和及时的治疗,强烈建议在48小时内进行治疗。
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治
疗
方
法
03
主动脉瘤破裂的
治疗
外科治疗包括用主动脉中的新血管替换受影响的血管,主动脉是为大脑、手臂和双腿供血的血管。此外,患者还接受了心脏瓣膜置换术以治疗瓣膜渗漏。所有复杂的外科手术均成功进行,治疗结果令人满意。通过综合康复治疗,患者可以完全康复,恢复腿部功能、步态和行走能力。这个成功病例的关键因素是在医院。主要贡献来自经验丰富的多学科团队和急救准备,如输血和先进技术。
破裂可分为两种主要类型:
1、源自前部的破裂贯穿背部并与腹腔相连;
2.源自后部并扩散至胸腔和腹部的破裂。这两组的死亡率有明显差异。如果破裂发生在前区,如果不及时治疗或治疗不当,高达90%的患者会在48小时内突然死亡。如果破裂位于后部,猝死的风险大大降低到30%。在这种情况下,以药物治疗为主,存活率为70%,手术治疗可使存活率提高到80-85%。然而,药物治疗比手术治疗要好得多。
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如
何
预
防
04
预防主动脉瘤
虽然主动脉瘤可以治疗,但最好的方法是尽可能保持健康。改变生活方式来预防主动脉瘤或防止动脉瘤恶化包括:
·健康饮食。多吃水果蔬菜,低脂奶制品。避免饱和脂肪,反式脂肪和限制盐。
·定期锻炼
·压力管理
·戒烟,如果吸烟
·保持健康的体重
·控制血压、血糖及胆固醇
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