妊娠期A型主动脉夹层研究现状及进展

李乐; 王萍

doi:10.13201/j.issn.1009-5918.2023.04.009

妊娠期A型主动脉夹层研究现状及进展

李乐¹,
王萍^1,Δ, ,

- 西部战区总医院急诊医学科(成都，610041)

详细信息

通讯作者: 王萍，E-mail：282210437@qq.com

^△审校者

中图分类号: R714.252

收稿日期: 2022-08-17

刊出日期: 2023-04-10

Research progress of type A aortic dissection in pregnancy

LI Le¹,
WANG Ping^1,Δ, ,

- Department of Emergency Medicine, General Hospital of Western Theater Command, Chengdu, 610041, China

More Information

Corresponding author: WANG Ping, E-mail: 282210437@qq.com

Received Date: 17 August 2022

Publish Date: 10 April 2023

摘要

摘要: 妊娠期发生A型急性主动脉夹层(type A acute aortic dissection，TAAD)无论对母亲还是胎儿来说都十分危险。相关研究提示受孕是妊娠期TAAD的独立危险因素。妊娠期TAAD的临床表现是非典型的，由于死亡风险高，应及时进行计算机断层扫描、磁共振成像或经食管超声心动图等影像学检查。妊娠期TAAD的手术治疗将会面临巨大挑战。本文通过检索国内外文献总结并概述目前围绕这一独特群体患者的研究和诊疗现状。
- 主动脉夹层 /
- 妊娠 /
- 治疗决策
Abstract: Type A acute aortic dissection(Type A acute aortic dissection, TAAD) during pregnancy is dangerous for mothers or babies. This article studies the existing theoretical assumptions because of the unique and dangerous research and independent status quo. The clinical manifestations of TAAD at the initial stage are atypical. Due to the high risk of death, computer tomography, magnetic resonance imaging or transesophageal echocardiography should be performed in time. Therefore, clinical strategies should be adopted for different stages from pregnant to postpartum. Surgical treatment mainly revolves around whether it occurs at the same time. Various operations and circulatory leaks can directly or cause harm to certain reasons. Measures and actions taken and relevant evidence for a certain period of time proves to be very lacking. Therefore, we carefully choose various clinical practices and research in the future.
- aortic dissection /
- pregnancy /
- treatment decision

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表 1 主动脉基础疾病的孕期风险监测指南^[34-36]

主动脉基础疾病	孕期风险	监测指南
马方综合征	最易导致孕期急性主动脉夹层。主动脉根部直径 < 40 mm的发生风险低于1%；40~50 mm的发生风险为10%；主动脉根部直径 > 45 mm为妊娠禁忌证	孕前选择性手术治疗，或每4~8周随访复查心脏彩超
主动脉瓣双瓣畸形	主动脉根部 > 40 mm时存在夹层风险；主动脉根部直径＞50 mm为妊娠禁忌证	主动脉根部直径 > 47 mm可选择性手术。
血管Ehlers-Danlos综合征	夹层发生的风险很高，曾认为是妊娠的禁忌证	妊娠并不会对患者的总生存造成影响，可讨论评估妊娠的意义
性腺发育不全	夹层发生风险高，若既往发生过夹层则为妊娠禁忌证	孕期至少1次心血管超声检查；产后6个月内，每1~2个月行心血管超声检查

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