慢性肺源性心脏病合并急性心肌梗死临床特点分析  

Analysis of Clinical Characteristics of Chronic Cor Pulmonale Combined with Acute Myocardial Infarction

作　　者：江国强[1] 王雅敏[1] 李峤珂[1] 

机构地区：[1]武警四川总队医院心内科,四川乐山614000

出　　处：《临床误诊误治》2013年第4期84-86,共3页Clinical Misdiagnosis & Mistherapy

摘　　要：目的探讨慢性肺源性心脏病(肺心病)合并急性心肌梗死(AMI)的临床特点,以减少误诊、漏诊。方法收集我院2004年6月—2012年6月收治的AMI 253例,比较44例慢性肺心病合并AMI(A组)与209例单纯AIM(B组)的临床表现、心电图特点及治疗转归。结果 A组胸痛发生率显著低于B组(P<0.01);急性左心衰竭、心源性休克、呼吸困难加重、心律失常发生率高于B组(P<0.05)。两组心电图特点比较,A组窦性心动过速、房性心律失常、右束支阻滞发生率高于B组(P<0.05)。A组在发病48 h内确诊30例(68.2%),14例就诊后延误了AMI诊断,误诊、漏诊率为31.8%。A组病死率(31.8%)显著高于B组(15.3%)(P<0.01),其中85.7%为误诊、漏诊病例。结论慢性肺心病合并AMI时,胸痛少见,容易漏诊。且并发症发生率高,预后不佳,临床应予重视。Objective To explore clinical features of chronic pulmonary heart disease （cor pulmonale） combined with acute myocardial infarction （AMI） in order to reduce missed diagnosis and misdiagnosis rates. Methods A total of 253 patients with AMI in our hospital during June 2004 and June 2012 were divided into cor pulmonale combined with AMI group （group A, n = 44） and AMI group （group B, n = 209 ）. Clinical manifestations, electrocardiogram characteristics and treatment turnovers of the two groups were compared. Results The incidence rate of chest pain in group A was significantly lower than that in group B （P 〈 0. 01 ） ; the incidence rates of acute left ventricular failure, eardiogenic shock, dyspnea exacerbation and arrhythmia in group A were significantly higher than those in group B （P 〈 0. 05 ）. The incidence rates of sinus tachyeardia, atrial arrhythmia and right bundle branch block in group A were higher than those in group B （P 〈 0. 05 ）. The 30 patients in group A were finally diagnosed in the first 48 h of pathogenesy （68.2%）, 14 patients were delayed in the diagnosis of AMI, and missed diagnosis or misdiagnosis rate was 31.8%. Fatality rate in group A was 31.8% , which was significantly higher than that in group B （ 15.3% ） （P 〈 0. 01 ）, and 85.7% of which were missed diagnosis and misdiagnosis cases. Conclusion Chest pain is infrequent when AMI combined with chronic cor pulmonale, and missed diagnosis and complications may occur with poor prognosis. Clinicians should pay more attention to it.

关 键 词：肺源性心脏病 心肌梗死 误诊 漏诊 

分 类 号：R541.5[医药卫生—心血管疾病] R542.22[医药卫生—内科学]