ST段抬高的致命陷阱：主动脉夹层
Fatal Pitfall of ST-Segment Elevation: Aortic Dissection
- 临床心电学杂志 2026年35卷第1期 页码：6-11
- 作者机构：
410300 湖南 浏阳，浏阳市人民医院心血管内科
- 作者简介：
[ "杨小燕，现任浏阳市人民医院心血管内科主治医师、硕士。致力于心血管内科的临床诊疗与科研工作，科研工作主要聚焦于心血管急危重症心电图，在学术研究方面，以第一作者及通讯作者发表SCI多篇，分别发表于《JAMA internal medicine》（Challenges in Clinical Electrocardiography）及《Circulation》（ECG Challenge）等国际知名临床期刊。现任湖南省老科协医疗健康分会心律学专业委员会委员等学术职务。，主要从事心血管内科的临床诊疗与科研工作。" ]
- 基金信息：
DOI：
中图分类号： R541.7 R540.4+1收稿：2026-01-24，
录用：2026-01-29，
纸质出版：2026-02-28
- 稿件说明：
移动端阅览
杨小燕. ST段抬高的致命陷阱：主动脉夹层[J]. 临床心电学杂志, 2026, 35(1): 6-11.
YANG Xiaoyan..Fatal Pitfall of ST-Segment Elevation: Aortic Dissection[J].J Clin Electrocardiol,2026,35(01):6-11.
摘要
40岁男性患者，突发持续性胸痛伴心电图广泛前壁、高侧壁ST段抬高。初期拟诊为急性心肌梗死并给予双联抗血小板治疗。但结合其双侧血压不对称、心电图ST段迅速回落、肌钙蛋白阴性而血浆D-二聚体显著升高（>10，000 ng/mL）等特征，高度怀疑急性主动脉综合征。主动脉CTA检查确诊为Stanford A型主动脉夹层累及左冠状动脉主干开口，患者成功接受手术后康复。急性主动脉夹层是一种致命性心血管急症，其临床表现常与急性冠脉综合征重合，极易导致误诊和不恰当的抗血小板治疗，进而增加致命性出血风险和死亡率。2024年ESC指南推荐，结合主动脉夹层检测风险评分（ADD-RS）与D-二聚体检测的多参数诊断策略可高效分流患者：对于低风险患者，D-二聚体阴性可有效排除夹层；对于中高风险患者，应立即进行确诊性影像检查以避免漏诊。胸痛患者的标准化的早期识别流程，是避免致命性延误，改善A型主动脉夹层患者预后的关键。
Abstract
A 40-year-old male patient presented with sudden-onset persistent chest pain accompanied by widespread anterior ST-segment elevation on electrocardiogram (ECG). Initially diagnosed as acute myocardial infarction (AMI)
he received dual antiplatelet therapy. However
a combination of clues including bilateral blood pressure asymmetry
rapid ST-segment resolution
negative troponin but strikingly elevated plasma D-dimer (>10
000 ng/mL) raised a high suspicion of acute aortic syndrome. Aortic computed tomography angiography (CTA) confirmed Stanford type A aortic dissection involving the left main coronary artery ostium. The patient underwent successful surgical repair. Acute aortic dissection(AAD)
particularly type A
is a life-threatening cardiovascular emergency. Its clinical presentation often overlaps with acute coronary syndrome (ACS)
leading to misdiagnosis
inappropriate antiplatelet therapy
and increased risk of catastrophic hemorrhage and mortality. The 2024 ESC guidelines recommend a multi-parameter diagnostic strategy combining the Aortic Dissection Detection Risk Score (ADD-RS) and D-dimer testing for efficient patient triage. For patients with low clinical risk
a negative D-dimer can effectively rule out dissection; for those with intermediate to high clinical risk
immediate confirmatory imaging is required to avoid diagnostic delay. Implementing a standardized early recognition algorithm for patients with chest pain is paramount to preventing fatal delays and improving outcomes in patients with type A aortic dissection.
关键词
Keywords
references
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