症状不典型急性心肌梗死临床误诊分析  

Clinical Analysis of Misdiagnosed Patients with Non Typical Acute Myocardial Infarction

作　　者：周致远[1] 李德才[1] 王庆旭[1] 

机构地区：[1]四川绵阳四〇四医院心血管内科,四川绵阳621000

出　　处：《临床误诊误治》2017年第2期25-28,共4页Clinical Misdiagnosis & Mistherapy

摘　　要：目的探讨症状不典型急性心肌梗死(acute myocardial infarction,AMI)临床特点、早期误诊原因及防范措施。方法对早期误诊的症状不典型急性心肌梗死35例的临床资料进行系统性回顾分析。结果本组均在我院首诊,误诊率27.78%,早期误诊为颈椎病压迫硬囊膜及低血压休克各6例,急性胃肠炎5例,肩周炎及急腹症各4例,腔隙性脑梗死及牙周炎各3例,支气管炎2例,心脏神经官能症及肺炎各1例。本组误诊时间3~19 h,均经心电图和心肌酶等检查确诊。确诊为前壁及前壁并高侧壁AMI各6例,下壁及高侧壁AMI各5例,广泛前壁及下壁并左室AMI各4例,下壁并右室AMI 3例,下壁并前壁AMI 2例。本组确诊后33例予抗凝、溶栓及扩张冠状动脉等对症治疗,32例病情明显好转,1例治疗无效死亡;2例拒绝治疗出院。结论 AMI病情复杂,临床表现多样,早期症状不典型者易误诊。接诊医师应加强对相关知识学习、发散诊断思维,临床遇及类似本文患者时需认真对病史进行采集、仔细查体、及时行相关检查、认真鉴别诊断,并综合全面对病情进行分析,以减少或避免AMI误诊误治。Objective To investigate clinical characteristics, early misdiagnosed causes and prevention methods for patients with non typical acute myocardial infarction （NTAMI）. Methods Clinical data of 35 misdiagnosed patients with NT- AMI during January 2015 and January 2016 was retrospectively analyzed. Results All the patients were primarily diagnosed in Mianyang 404 hospital, and the misdiagnosed rate was 27.78% , among whom 6 patients were early misdiagnosed as having cervical spondylosis oppression hard capsule, 6 patients as having hypotension shock, 5 patients as having acute gastroenteritis, 4 patients as having adhesive capsulitis, 4 patients as having acute abdomen, 3 patients as having lacunar infarction, 3 patients as having periodontitis, 2 patients as having bronchitis, 1 patient as having neurosis and 1 patient as having pneumonia. The average time of misdiagnosis was 3-19 h, and AMI was confirmed in all patients by examination results of electrocar- diogram （ECG） and myocardial enzymes. Among the 33 patients, 6 patients were confirmed as having anterior wall AMI, 6 patients as having anterior wall and high lateral wall AMI, 5 patients as having inferior wall AMI, 5 patients as having high lateral wall AMI, 4 patients as having extensive anterior wall AMI, 4 patients as having inferior wails combined with left ven- tricle AMI, 3 patients as having inferior wall and right ventricle AMI, and 2 patients as having interior and anterior walls AMI, Symptomatic treatments such as anticoagulant, thrombolysis and extension of coronary artery were performed for the 33 patients after confirming diagnosis, and then conditions were obviously improved in 32 patients, 1 patient died of treatment fu- tility, and 2 patients were discharged because of refusal of treatment. Conclusion Patients with non typical acute myocardial infarction in early period is easily misdiagnosed because of complex conditions and various clinical characteristics, clinicians should enhance learning related knowledge, comprehensively think,

关 键 词：心肌梗死 误诊 颈椎病 休克 胃肠炎 

分 类 号：R542.22[医药卫生—心血管疾病]