非冠心病胸痛患者的临床分析  

Clinical Analysis of Non-Coronary Artery Disease Patients With Chest Pain

作　　者：雒芳玲[1] 白墨青[1] 王晓冬[1] 宋振国[1] 史东[1] 林文华[1] 张峰[1] 任自文[1] 

机构地区：[1]天津医科大学泰达国际心血管医院内一科,天津市300457

出　　处：《中国循环杂志》2011年第4期267-270,共4页Chinese Circulation Journal

摘　　要：目的:分析非冠心病胸痛患者的疾病特点,延误诊断原因,胸痛病因,提出避免延误诊断的建议。方法:因胸痛怀疑冠心病住院的241例患者,首次冠状动脉造影(CAG),冠状动脉计算机断层摄影术(CTCA)及核素心肌灌注显像(SPECT)检查,筛选出106例非冠心病胸痛患者。通过病历、调查表和电话随访收集相关资料,并从危险因素、胸痛特点以及精神状态等方面与同期首次行CAG检查确诊为冠心病的患者122例进行对比分析。结果:非冠心病患者与冠心病患者比较发病年龄较小,女性较多,误诊时间较长(P均<0.001～0.05),差异有统计学意义。66.0%的患者依据心电图和超声心动图,14.2%的患者依据胸痛特点诊断为冠心病,未行进一步检查。53.8%的患者长期服用治疗冠心病的药物,平均医疗费用(2.84±2.62)万元,为CAG费用的4.73倍。53.8%的患者因医师,35.8%的患者由于自身原因延误诊断。神经、心理、精神因素(51.1%),消化道疾病(21.5%),颈椎病(14.8%)是导致非冠心病胸痛的主要病因。非冠心病胸痛患者预后较好。排除冠心病以后85.2%的患者胸痛情况明显好转,90.9%停服扩血管药,精神状态明显改善。结论:根据临床特点及无创性检查不能明确排除冠心病的胸痛患者应该尽早进行CAG或CTCA检查明确诊断,从而避免误诊和浪费医疗资源,减轻患者的心理负担,切忌盲目滥用冠心病药物治疗。提高患者及接诊医师明确诊断的观念至关重要。Objective：To analyze the characteristics and cause of misdiagnosis of chest pain in non-coronary artery disease（CAD）patients in order to improve the accuracy of chest pain diagnosis. Methods：A total of 241 suspected CAD patients were admitted and received coronary angiography（CAG）,coronary CT（CTCA） and radionuclide myocardial perfusion imaging（SPECT） examination.It turned out that 106 patients without CAD,and 122 patients with CAD.We compared those two groups of patients by the relevant information through their medical records,questionnaires and telephone follow-up for the risk factors,chest pain characters and mental status.13 patients were excluded from this study. Results：Compared with CAD patients,non-CAD patients had the younger age,more female gender and with the longer history of misdiagnosis,P0.001~0.05 respectively.There were 66.0% of non-CAD cases were misdiagnosed by ECG and echocardiography,and 14.2% were misdiagnosed by the character of chest pain without further necessary examinations.53.8% of non-CAD patients were treated as CAD,their medical cost was about 4.73 times higher than CAD treatment.53.8% of non-CAD cases were misdiagnosed by physicians and 35.8% were misdiagnosed for their own reasons.The major cause of non-CAD chest pain including the nerve,mental,spiritual factors（51.1%）,gastrointestinal diseases（21.5%） and cervical disease（14.8%）.After excluding CAD,85.2% of patients had improved symptoms and 90.9% of patients stopped taking CAD medication,the mental status improved significantly. Conclusion：CAG or CTCA are necessary examinations for suspected patients who could not be accurately diagnosed.The medication for CAD should not be used until the diagnosis is clear.Both physician and patient must be alert for the diagnosis.

关 键 词：非冠心病胸痛 临床特点 误诊原因 病因 

分 类 号：R541[医药卫生—心血管疾病]