以咽喉部症状为主诉的隐匿性冠心病42例临床分析  

Clinical analysis in 42 cases with latent coronary heart disease presenting with throat symptoms

作　　者：蔡虹[1] 孙晓强[1] 覃纲[1] 费静[1] 赵冲[1] 代嘉虹[2] 谭蓓蓓[3] 李雷激[1] 

机构地区：[1]泸州医学院附属医院耳鼻咽喉头颈外科,四川泸州646000 [2]泸州医学院附属医院物理诊断科,四川泸州646000 [3]泸州医学院附属医院核医学科,四川泸州646000

出　　处：《中国耳鼻咽喉颅底外科杂志》2016年第2期138-141,共4页Chinese Journal of Otorhinolaryngology-skull Base Surgery

摘　　要：目的探讨隐匿性冠心病与咽喉部诸多症状之间的联系,提高对以咽喉部症状为主诉的、存在重大安全隐患的隐匿性冠心病的认识。方法回顾性分析42例以咽喉部症状为主诉首诊于耳鼻咽喉科门诊患者的临床资料。其中以咽喉部梗阻感为主诉的18例,咽喉部闷胀痛8例,咽喉部紧缩感7例,吞咽困难5例,咽喉部烧灼感2例,气、食管上方的不适或疼痛2例。本组患者既往均无胸痛、胸闷、心悸等心肌缺血症状及病史,有一次或多次就诊于耳鼻咽喉科门诊且诊断为相关耳鼻喉科疾病的病史。本组咽喉部症状均有短暂性发作的特点,持续时间常为5~10 min。结果所有患者均经静息、动态或负荷试验的心电图检查、放射性核素心肌显影等证实有心肌缺血表现,并由我院心内科确诊为隐匿性冠心病。经内科控制冠心病危险因素及抗心肌缺血治疗后,咽喉部症状消失33例,缓解9例（其中合并颈椎病5例、反流性食管炎4例）。所有患者均无猝死、心肌梗塞、心力衰竭、恶性心律失常等冠心病并发症发生。结论对于具备冠心病易患因素、咽喉部症状有发作性特点的患者,不管既往有无心肌缺血症状,都应及时行动态心电图等检查,避免隐匿性冠心病导致的严重冠脉急性事件的发生。Objective To investigate the link between latent coronary heart disease and symptoms of pharynx and larynx,and to raise the awareness of possibility and significant security risks of latent coronary heart disease presenting with throat symptoms. Methods Clinical data of 42 cases consulting otolaryngologists first due to throat symptoms and finally confirmed with latent coronary heart disease were analyzed retrospectively. Their symptoms included throat obstruction sense（ n = 18）,throat stuffy pain（ n = 8）,sense of throat austerity（ n = 7）,dysphagia（ n = 5）,throat burning sense（ n= 2）,discomfort or pain of upper tracheo-esophagus（ n = 2）. All the symptoms were characterized by transient episodes,lasting for 5 to 10 minutes. No patients had symptom or history of myocardial ischemia such as chest pain,heart palpitations. They had the experience of consulting otolaryngologists once at least,and relevant diseases were diagnosed.Results Myocardial ischemia was confirmed in all the 42 patients by resting,dynamic electrocardiography（ ECG）,ECG stress testing,or radionuclide myocardial imaging. Latent coronary heart diseases were diagnosed by cardiologists. After controlling risk factors of coronary heart disease and anti-ischemic treatment,the throat symptoms got disappeared in 33 cases and relieved in 9. Of the latter 9 cases,5 had cervical spondylosis and 4 had reflux esophagitis in addition. No sudden death,myocardial infarction,heart failure,arrhythmia and other complications of severe coronary heart disease occurred in all the patients. Conclusion For patients with paroxysmal symptoms of pharynx and larynx,in order to avoid the occurrence of severe coronary events caused by latent coronary heart disease,once risk factors of coronary heart disease exist,dynamic electrocardiogram and other related tests should be performed,regardless of whether with or without symptoms and history of myocardial ischemia.

关 键 词：咽喉不适 隐匿性冠心病 耳鼻咽喉科 心内科 诊断 

分 类 号：R541.4[医药卫生—心血管疾病] R766.5[医药卫生—内科学]