门诊心电图诊断急性心肌梗死患者的临床分析  

Analysis of the Clinical in the Acute Myocardial Infaretion Patients Diagnosed by the Clinic Electrocardiogram

作　　者：宫力红[1] 李俊华[1] 汪爱虎[1] 杨新春[1] 

机构地区：[1]北京市朝阳医院,北京100020

出　　处：《实用医技杂志》2006年第24期4309-4310,共2页Journal of Practical Medical Techniques

摘　　要：目的:总结门诊心电图诊断不典型急性心肌梗死患者的资料,发现其中的特殊性和规律,提高临床医生对这类患者的认识,以免延误治疗时机。方法:收集门诊心电图室发现的51例急性心肌梗死患者的临床资料,包括临床病史、心电图、心肌酶谱、心脏彩超、冠脉造影,进行统计分析。结果:51例心肌梗死患者胸痛症状不典型,表现为胸痛、胸闷、头晕、恶心41例,到心内科就医;头痛、头晕3例,到神经内科就医;腹部不适、恶心、呕吐3例,到消化内科就医;胸闷、憋气、头痛4例,到中医科就医。从胸痛至就诊时间3d^7d。门诊心电图发现:下壁心肌梗死17例,下后壁合并右室心肌梗死7例,前壁心肌梗死11例,前间壁心肌梗死8例,非Q波心肌梗死8例。冠脉造影结果示左前降支(LAD)11例,左回旋支(LCX+LAD)14例,右冠状动脉(RCA+LAD+LCX)16例。结论:不典型心肌梗死的患者除胸痛、胸闷外,可表现为头痛、腹痛、咽部不适、恶心、呕吐等,临床医生应提高警惕,及时做心电图、血清酶等检查,及时发现和诊断出不典型心肌梗死。Objective To find the specificity and rules from summarizing data of the acute myocardial infarction patients diagnosed by the clinic electrocardiogram in order to enhance clinician vigilance and avoid missing the optimal time of treatment. Methods To collect and analyze clinical data of 51 acute myocardial infarction patients diagnosed firstly by the clinic electrocardiogram in the out-patient clinic, including history, electrocardiogram, myocardial creatase, coronary angiography. Results Forty-one patients who had chest pain and chest distress visited cardiology department ;3 who took headache and dizziness visited neurological department;3 who had abdominal discomfort nausea and vomiting visited digestive department; and 4 who had chest distress and short of breath visited traditional Chinese medicine department. There were about 3 to 7 days from displaying chest pain to seeing a doctor. There were 17 patients with inferior myocardial infarction,7 with inferior-posterior and right ventricle myocardial infarction, 11 with anterior myocardial infarction,8 with anterior-interior myocardial infarction and 8 patients with non-Q wave infarction diagnosed firstly by the clinic elec trocardiogram. The results of coronary angiography showed that the IRA （ infarction related artery） were LAD （ 11 patients）, LAD ＋ LCX （ 14 patients）, LAD ＋ LCX ＋ RCA （ 16 patients）. Conclusion Acute myocardial infarction might display headache, abdominal pain, nausea and vomiting and so on except chest pain and chest distress. Clinician should enhance the vigilance in order to diagnose atypical AMI in time by electrocardiogram, myocardial creatase et al.

关 键 词：不典型心肌梗死 心电图 侧支循环 冠脉造影 

分 类 号：R542.22[医药卫生—心血管疾病]