透析中高血压诱发维持性血液透析患者Stanford B型主动脉夹层1例并文献复习

doi:10.3969/j.issn.1004-583X.2026.07.010

摘要/Abstract

摘要：

目的探讨血液透析患者并发主动脉夹层的临床特征、诊断及经验分享。方法回顾性分析维持性血液透析患者并发Stanford B型主动脉夹层1例,并复习相关文献。结果患者青年男性, 主因维持性血液透析5年余,透析中胸痛1 h入院。患者平素存在严重的继发性甲状旁腺功能亢进症和钙磷代谢紊乱,患者在血液透析开始1 h后出现剧烈胸痛,疼痛发作时,测得血压升高至196/103 mmHg,终止血液透析后行全主动脉计算机断层扫描血管成像检查提示:Stanford B型(Debakey Ⅲ型)。心血管内科行主动脉夹层腔内隔绝术,术后恢复顺利,预后良好,继续维持性血液透析。结论合理控制血液透析患者透析中高血压、积极调控甲状旁腺激素和高磷血症是防止主动脉夹层事件发生的关键。

关键词: 肾透析, 主动脉夹层, 透析中高血压

Abstract:

Objective To investigate the clinical characteristics, diagnosis, and management of aortic dissection (AD) in patients undergoing hemodialysis through a case report and literature review. Methods We retrospectively analyzed one case of Stanford type B AD in a patient undergoing maintenance hemodialysis (MHD) and reviewed the relevant literature. Results The patient was a young man who had been receiving MHD for more than 5 years and was admitted because of chest pain during dialysis for 1 h. He had longstanding severe secondary hyperparathyroidism and disorders of calcium-phosphorus metabolism. After 1 h of hemodialysis, the patient developed sudden severe chest pain. At the time of symptom onset, blood pressure was measured at 196/103 mmHg. After hemodialysis was terminated, whole-aorta computed tomography angiography showed Stanford type B (Debakey type III) AD. The patient subsequently underwent endovascular aortic repair in the cardiovascular department, recovered smoothly after surgery, and had a favorable prognosis while continuing MHD. Conclusion Appropriate control of intradialytic hypertension and active management of parathyroid hormone levels and hyperphosphatemia are key to preventing AD in patients undergoing hemodialysis.

Key words: renal dialysis, aortic dissection, intradialytic hypertension

中图分类号:

R459.5

李国刚, 董佩, 雷莉. 透析中高血压诱发维持性血液透析患者Stanford B型主动脉夹层1例并文献复习[J]. 临床荟萃, 2026, 41(7): 638-641.

Li Guogang, Dong Pei, Lei Li. Intradialytic hypertension-induced Stanford type B aortic dissection in a patient undergoing maintenance hemodialysis: A case report and literature review[J]. Clinical Focus, 2026, 41(7): 638-641.

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链接本文: https://www.lchc.cn/CN/10.3969/j.issn.1004-583X.2026.07.010

https://www.lchc.cn/CN/Y2026/V41/I7/638

图/表 2

图1 全主动脉CTA冠状面 a.降主动脉夹层(红色箭头所示);b.主动脉弓夹层(红色箭头所示)

Fig.1 Coronal whole-aorta CTA images: a. Descending aortic dissection (indicated by the red arrow); b. Aortic arch dissection (indicated by the red arrow)

图2 CTA三维重建显示夹层从左锁骨下动脉向远端延伸(红色箭头所示)

Fig.2 CTA three-dimensional reconstruction showing the dissection extending distally from the left subclavian artery (indicated by the red arrow)

参考文献 18

[1]	Stombaugh DK, Mangunta VR. Aortic dissection[J]. Anesthesiol Clin, 2022, 40(4):685-703. doi:10.1016/j.anclin.2022.08.012. pmid: 36328623
[2]	Carrel T, Sundt TM 3rd, von Kodolitsch Y, et al. Acute aortic dissection[J]. Lancet, 2023, 401(10378):773-788. doi:10.1016/S0140-6736(22)01970-5.
[3]	Symonides B, Lewandowski J, Małyszko J. Resistant hypertension in dialysis[J]. Nephrol Dial Transplant, 2023, 38(9):1952-1959. doi:10.1093/ndt/gfad047.
[4]	Imburgio S, Arcidiacono A, Klei L, et al. Hypertensive emergency during dialysis: A paradoxical physiologic response[J]. Cureus, 2024, 16(5):e60304. doi:10.7759/cureus.60304.
[5]	Stack BC Jr. Secondary hyperparathyroidism[J]. Otolaryngol Clin North Am, 2024, 57(1):99-110. doi:10.1016/j.otc.2023.07.010.
[6]	Bojko M, Fleischman F. Aortic dissection: Diagnosis[J]. Cardiol Clin, 2025, 43(2):209-217. doi:10.1016/j.ccl.2024.11.001. pmid: 40268351
[7]	Malik A, Longi F, Naeem A, et al. Outcomes in patients with chronic renal failure on hemodialysis after aortic valve or root replacement[J]. Semin Thorac Cardiovasc Surg, 2022, 34(3): 880-888. doi:10.1053/j.semtcvs.2021.05.019.
[8]	Nakano Y, Mandai S, Mori Y, et al. Nationwide mortality following acute type B aortic dissection and the survival advantage of obesity among dialysis patients in Japan[J]. J Nephrol, 2025, 38(2):503-510. doi:10.1007/s40620-024-02147-8.
[9]	Echefu G, Stowe I, Burka S, et al. Pathophysiological concepts and screening of cardiovascular disease in dialysis patients[J]. Front Nephrol, 2023, 3: 1198560. doi:10.3389/fneph.2023.1198560.
[10]	Cook I, Green S, Rebello K, et al. Comparison of open thoracoabdominal repair for chronic aortic dissections and aneurysms[J]. J Vasc Surg, 2024, 80(2): 323-335. doi:10.1016/j.jvs.2024.03.026.
[11]	Wang Z, Ge P, Lu L, et al. Surgical outcomes of acute type A aortic dissection in dialysis patients: Lessons learned from a single-center’s experience[J]. Sci Rep, 2022, 12(1):5372. doi:10.1038/s41598-022-09448-7.
[12]	Mach M, Ostrowski T, Giba A, et al. Complex management of extensive stanford type B aortic dissection with multiorgan failure and acute limb ischemia treated by femoro-femoral bypass and complicated by iatrogenic brachial arteriovenous fistula: A case report[J]. Cureus, 2025, 17(7):e88173.doi:10.7759/cureus.88173.
[13]	Campos I, Faul C. Elevated phosphate levels in CKD-a direct threat for the heart[J]. Nephrol Dial Transplant, 2025, 40(7):1294-1309. doi:10.1093/ndt/gfaf001.
[14]	Vendramin I, Piani D, Lechiancole A, et al. Do oral anticoagulants impact outcomes and false lumen patency after repair of acute type A aortic dissection?[J]. Thorac Cardiovasc Surg, 2023, 166(1):38-48.e4. doi:10.1016/j.jtcvs.2021.09.009.
[15]	Matniyaz Y, Luo Y, Jiang Y, et al. Short-and Long-term survival prediction in patients with acute type A aortic dissection undergoing open surgery[J]. J Cardiothorac Surg, 2024, 19(1): 171. doi:10.1186/s13019-024-02687-x.
[16]	Chang H, Rockman C, Cayne N, et al. Anticoagulation and antiplatelet medications do not affect aortic remodeling after thoracic endovascular aortic repair for type B aortic dissection[J]. J Vasc Surg, 2021, 74(6):1833-1842.e1. doi:10.1016/j.jvs.2021.05.059. pmid: 34182028
[17]	Liu H, Yuan Z, Zhang Z, et al. Notch1 gene promoter methylation promotes phenotypic transformation and functional alteration of VSMCs to regulate acute type A aortic dissection[J]. Biochim Biophys Acta Gen Subj, 2026, 1870(6): 130918. doi:10.1016/j.bbagen.2026.130918.
[18]	Allman R, Rogers A, Popowic P, et al. Analysis of racial disparities in acute type A aortic dissection repair at a rural tertiary academic medical center[J]. J Card Surg, 2021, 36(11): 4238-4242. doi:10.1111/jocs.15971. pmid: 34499373