急性胸痛患者的病因调查及胸痛中心对胸痛患者诊疗时间的影响  

Investigation for etiologies of acute chest pain and value of chest pain center for hospital improvement in time for diagnosis and treatment in patients with acute chest pain

作　　者：张健[1] 胡大一[1] 孙金勇[1] 王显[1] 郭实[1] 杨士伟[2] 石宇杰[1] 徐威[1] 李晓明[1] 路敏[1] 

机构地区：[1]中国人民解放军北京军区总医院心内科,北京100700 [2]首都医科大学附属北京安贞医院12病房

出　　处：《临床心血管病杂志》2010年第8期618-620,共3页Journal of Clinical Cardiology

基　　金：国家人事部中国博士后科学基金(No:20070410504)

摘　　要：目的:对急性胸痛患者的病因进行调查研究,并观察胸痛中心对急性胸痛患者诊疗时间的影响。方法:胸痛中心每周开诊3d,时间随机确定,其余时间由急诊科按常规流程对胸痛患者进行诊疗,由研究者对急性胸痛患者的病因和诊疗时间进行注册登记。结果:2006-01-2007-12因急性非创伤性胸痛就诊急诊科非胸痛中心或胸痛中心的患者共696例,心源性胸痛244例(35%),包括急性心肌梗死141例(20%),不稳定型心绞痛81例(12%),稳定型心绞痛17例(2.4%),主动脉夹层2例(0.3%),急性肺栓塞3例(0.4%);非心源性胸痛452例(65%),呼吸系统41例(6%),消化系统70例(10%),胸膜骨骼肌肉41例(6%),神经精神或其他299例(42%)。经胸痛中心诊治的急性心肌梗死、不稳定心绞痛、非心源性胸痛患者的诊疗时间分别为(70.1±31.7)min、(3.8±0.9)h、(1.8±1.1)h,较非胸痛中心诊治时间[(115±40.5)min、(4.4±1.3)h、(2.1±1.6)h]均有所缩短(P<0.01、P<0.05、P<0.05)。结论:急性胸痛患者的病因中,心源性者占35%(以急性心肌梗死和不稳定型心绞痛为主),非心源性者占65%;胸痛中心模式能显著缩短急性胸痛患者的诊疗时间。Objective：To investigate the etiologies of acute chest pain and the value of chest pain center （CPC） for hospital improvement in time for diagnosis and treatment in patients with acute chest pain.Method：CPC was set up at the emergency department （ED） and there were three open days weekly which were randomly selected at the CPC.The patients were diagnosed and treated by ED physicians according to routine clinical pathway at the rest time of the week.The etiologies of chest pain and time for diagnosis and treatment were recorded.Result：The total of 696 nontraumatic chest pain patients visited ED/CPC from January 2006 to December 2007,of which 244 （35%） cases were cardiac chest pain cases including 141 （20%） cases of AMI,81 （12%） cases of unstable angina pectoris,17 （2.4%） cases of stable angina pectoris,2 （0.3%） cases of acute aortic dissection and,3 （0.4%） cases of acute pulmonary embolism.452 cases were noncardiac chest pain patients including 41 （6%） cases of respiratory diseases,70 （10%） cases of digestive diseases,41 （6%） cases of chest wall diseases and,299 （42%） cases of psychological-psychotic diseases and other undetermined clinical conditions.Time for diagnosis and treatment for chest pain patients who visited CPC was significantly shortened.AMI：（70.1±31.7） vs （115±40.5） min,P0.01;unstable angina pectoris：（3.8±0.9） vs （4.4±1.3）h,P0.05;noncardiac chest pain：（1.8±1.1） vs （2.1±1.6）h,P0.05.Conclusion：This study reveals among chest pain visitors to ED/CPC,cardiac etiologies account for 35% mainly including AMI and unstable angina pectoris,noncardiac etiologies account for 65%.Time for diagnosis and treatment for chest pain patients is significantly shortened by CPC.

关 键 词：急性胸痛 病因学 胸痛中心 诊疗时间 

分 类 号：R441.1[医药卫生—诊断学]