| Objective: Discuss the risk factors, clinical manifestations, diagnosis, treatments andthe causes of death early in hospital of aortic dissection (AD), so that we can have a better understanding of the disease , and improve the rate of early diagnosis, reduce the misdiagnosis and mortality.Methods:78 cases of AD patients in the First Hospital of Jilin University from January 2001 to March 2009 were analyzed retrospectively. We analysised the ages, genders, risk factors, clinical manifestations, examinations, treatments of all patients, all patients were divided into the death group and the survival group, we compared the ages, gendesr, types, whether with surgery or interventional therapy and the emergence of shock, AMI, ARF, the performance of the nervous system, severe aortic insufficiency, pericardial and (or) pleural effusion of the two groups .SPSS11.5 software was used to analysis, we used percentage or ratio to describe the count data , the chi-square test was used to compare inter-group. Mean±standard deviation (x±S) were used to dscribe measurement data, we used independent sample T test to compare inter-group; P<0.05 is statistical significantly.Results:1. There were 57 cases of male patients (73.08%), 21 females (26.92%), the ratio was 2.71:1, the youngest was 17-year-old, the oldest was 82 years old, the average age was (53.1±15.54) years old. The average age of male patients was (51.9±14.5) years old, the average age of female patients was (56.5±17.6) years old, there was no significant difference (P>0.05) between the males and the females. The peak ages of AD was 40 to 49-year-old (19.23%) and 50 to 59-year-old (33.33%), followed by 60~69-year-old (12.82%) and up 70-year-old (16.67 %), but there was no significant difference (P>0.05) among the percentages of all ages of AD.2. The risk factors of AD were hypertension (73.08%), smoking (24.36%), Marfan syndrome (14.10%), alcohol (6.41%) and others (8.97%), there were a variety of factors in some of the patients, among them, hypertension is the most important. As the basic diseases, we compared Marfan Syndrome and hypertension, and found that in patients with Marfan syndrome, the average age of incidence was significantly lower than that of high blood pressure group, and the difference was significant (P<0.05); we compared the incentives, genders, sub-type between the two groups, but we found that there was no significant difference (P>0.05); Pain as the first symptom, it was significantly less in patients with Marfan syndrome than patients with hypertension, the difference was significant (P<0.05).3. The clinical manifestations of AD were complex and diverse, but the main clinical manifestations still were pain (80.77%) and hypertension (84.62%). The nature of pain had always been described as severe, intolerable, tearing-like, cut-like, quickly disseminated and at the same time with a sense of dying and fear.4. All the methods of the diagnosis, the sensitivity of D-dimer was 88.89%; the X-ray of chest and ECG is not specific in the diagnosis of AD, but they played a certain role in identifying the different diagnosis; The ultrasound of the heart played an important role in the diagnosis of A-AD (the diagnosis rate is 77.55%), at the same time it can provide information of cardiac function and the valves; MRI, MSCTA and aortography can be used to diagnose AD. It stressed the important position and the convenience of the ultrasound in the diagnosis of AD; The role of MSCTA in the diagnosis of AD and the applications become increasingly important.5. The main treatment of AD is still the medical treatment, in acute phase, the mortality of patients with medical treatment alone of A type(37.29%) was significantly higher than B type (18.18%), but the mortality in acute phase was not statistically significant (P>0.05).6. There were no significant difference (P>0.05) in the ages, genders, with surgeries or interventional therapies or not, whether or not involving the nervous system, whether there was cardiac and (or) pleural effusion between the survival and death groups; but there were significantly difference (P<0.05) between the patients with acute renal failure, shock, acute myocardial infarction and severe aortic insufficiency and the patient without these complications.Conclusion:1. Hypertension, Marfan syndrome, smoking, drinking, male, age are the common risk factors and the basic diseases of AD, the hypertension is the most inportant, Marfan syndrome patients with AD are usually within 40 years old.2. The clinical manifestations of AD is complex , and every system can be involved, but painess and high blood pressure are the main manifestations, it is recommended that the doctors should pay attention to the description of the painess.3. The imaging plays a decisive role in the diagnosis of AD .Aortic angiography is not a routine examination. Chest X-ray and electrocardiogram can not give a definite diagnosis of AD, but play a certain role in identifying the different diagnosis ;The color Doppler ultrasound paly an important role in the diagnosis of type A-AD, at the same time it can provide information of cardiac function and the valves; It stressed the important position and the convenience of the ultrasound in the diagnosis of AD; The role of MSCTA in the diagnosis of AD and the applications become increasingly important.4. If the nervous system was involved , and pericardium and (or) pleural effusion, acute renal failure, shock, acute myocardial infarction and severe aortic valve insufficiency appeared in patients with AD, often indicated poor prognosis and high mortality, so clinicians should be more alert when the situations above appear, and should communicate with their families actively.
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