Abstract:

Objective To construct a symptom network in patients with acute type A aortic dissection （ATAAD），so as to provide theoretical basis for the screening of dissection ATAAD during emergency pre-screening triage. Methods There were 433 patients diagnosed with ATAAD during 2019 to 2023 in an emergency department of a tertiary hospital in Wuhan. Their basic information and medical records were reviewed by self-designed data questionnaire. UCINET6.0 software was used to construct a symptom network，analyze the centrality index and determine the core symptoms. Symptom distribution of patients with positive and negative blood pressure in extremities was analyzed in the further. Results The most common symptoms in patients with type A aortic dissection were chest pain（77.37%），back pain（42.96%），and sweating（29.79%）. In the symptom network，chest pain had the highest degree（r_s=659）. The closeness of chest pain，chest tightness，shortness of breath，back pain，nausea and vomiting，limb numbness and fatigue were same（r_c=93.33）. Fatigue has the highest betweenness（r_b=13.69）. Patients with positive limbs blood pressure mainly reported chest pain（70.17%），back pain（44.96%），and nausea and vomiting（19.33%），while those with negative limb blood pressure mainly reported chest pain（63.64%），back pain（63.64%），and orosphyalgia（39.40%）. Orosphyalgia had the highest degree（r_s=20）. Conclusion The symptoms of ATAAD are complex and varied in patients. During triage，nurses should measure the limb blood pressure when patients complained chest pain alone or when combined with other hypoperfusion symptoms，such as back pain，chest tightness，sweating，near-death sensation，and shortness of breath. Aortic dissection cannot be ruled out in patients with negative blood pressure when they had chest pain，back pain or orosphyalgia.

Key words: Aortic Dissection, Symptom Network, Limb Blood Pressure, Emergency Triage, Nurse

摘要：

目的 构建急性A型主动脉夹层患者的症状网络，为其在急诊预检分诊时的筛查提供理论依据。 方法 采用回顾性研究设计，纳入2019年—2023年武汉市某三级甲等综合医院急诊科的433例急性A型主动脉夹层患者作为调查对象，对患者的一般资料及症状资料进行分析。使用UCINET 6.0软件构建症状网络，分析中心性指标并确定急性A型主动脉夹层患者的核心症状。进一步分析不同四肢血压患者症状分布情况。 结果 急性A型主动脉夹层患者最常见的症状是胸痛（77.37%）、背痛（42.96%）和大汗（29.79%）。在症状网络中，强度最大的症状是胸痛（r_s=659）。胸痛、胸闷、气促、背痛、恶心呕吐、肢体麻木、乏力症状的紧密度相同（r_c=93.33）。中介度最大的症状为乏力（r_b=13.69）。四肢血压阳性患者症状主要为胸痛（70.17%）、背痛（44.96%）、恶心呕吐（19.33%）；而四肢血压阴性的患者症状主要为胸痛（63.64%）、背痛（63.64%）和腹痛（39.40%），强度最大的症状为腹痛（r_s=20）。 结论 急性A型主动脉夹层症状复杂多样，护士在预检分诊时应对单独出现胸痛或胸痛合并其他灌注不足如背痛、胸闷、大汗、濒死感、气促症状的患者重点进行四肢血压的测量。四肢血压阴性患者如出现胸痛、背痛、腹痛时，仍不可排除急性A型主动脉夹层。

关键词: 主动脉夹层, 症状网络, 四肢血压, 急诊预检分诊, 护士