急性冠状动脉综合征急诊分层诊断临床应用可行性探讨  

Feasibility of Clinical Application in Hierarchical Diagnosis of Patients with Acute Coronary Syndrome in Emergency Cases

作　　者：尹红军[1] 董晖[1] 刘杰[1] 金爱春[1] 蒋志锋[1] 李树[1] 刘福军[1] 

机构地区：[1]首都医科大学潞河教学医院急诊科,北京101149

出　　处：《临床误诊误治》2014年第7期22-25,共4页Clinical Misdiagnosis & Mistherapy

摘　　要：目的探讨急性冠状动脉综合征(acute coronary syndrome,ACS)急诊分层诊断的可行性,提高急诊医生对ACS的诊断水平。方法选择2013年3—8月因胸痛及胸痛等同症状在我院急诊科就诊且资料完整患者288例,通过急诊分层诊断流程及标准将患者分为ACS组(192例)和非ACS组(96例),观察两组一般情况、确诊结果及临床转归情况,并分析急诊分层诊断流程及标准对ACS诊断的敏感性及特异性。结果两组性别、症状出现时间差异有统计学意义(P<0.05),年龄差异无统计学意义(P>0.05)。ACS组经冠状动脉造影确诊为ACS 173例,非ACS组中确诊ACS 3例,ACS组初诊诊断符合率90.1%(173/192),非ACS组初诊诊断符合率96.9%(93/96)。急诊分层诊断流程及标准对ACS诊断的敏感性为98.3%,特异性为83.0%。ACS组住院期间死亡2例,非ACS组随访30 d无死亡病例。结论对因胸痛及胸痛等同症状就诊的急诊患者行ACS分层诊断,可初步实现ACS的早期诊断及规范化治疗,降低漏诊率,避免过度医疗。Objective To explore the feasibility of hierarchical diagnosis for patients with acute coronary syndrome （ACS） in order to improve the diagnostic ability of ACS in emergency department （ED）. Methods A total of 288 patients with chest pain or equivalent symptom from March to August 2013 were divided into ACS group （n = 192） and non-ACS group （n = 96） according to hierarchical diagnostic flowsheet. The general conditions, definite diagnostic outcomes and clinical turn-over by following up in the two groups were observed, and sensitivity and specificity of diagnostic flowsheet and standard using hierarchical diagnosis were analyzed. Results The differences in gender and symptom occurrence time in the two groups were statistically significant （P 〈 0. 05）, but the difference in ages was not statistically significant （P 〉 0. 05）. A total of 173 pa-tients were confirmed with having the ACS by coronary arteriongraphy in ACS group, and 3 patients were confirmed with having the ACS in non-ACS group. The accordance rate of preliminary diagnosis in ACS group was 90. 1% （173 / 192）, while the rate in non-ACS group was 96. 9% （93 / 96）. The sensitivity was 98. 3% , and specificity was 83. 0% . Two patients died in＆amp;nbsp;hospital in ACS group, but no one died in non-ACS group with follow-up for 30 d. Conclusion ACS hierarchical diagnosis in patients with chest pain or equivalent symptom can achieve preliminary ACS early diagnosis and standardized treatment in order to reduce misdiagnosis rate and avoid excessive therapy.

关 键 词：急性冠状动脉综合征 分层诊断 早期诊断 误诊 

分 类 号：R541.4[医药卫生—心血管疾病]