主动脉夹层误诊为急性心肌梗死15例分析并文献复习  

Fifteen Cases of Aortic Dissection Misdiagnosed as Acute Myocardial Infarction: Case Analysis and Literature Review

作　　者：于华[1] YU Hua(Department of Geriatrics,the First Hospital of Shijiazhuang,Shijiazhuang 050011,China)

机构地区：[1]石家庄市第一医院老年病科,石家庄050011

出　　处：《临床误诊误治》2018年第4期4-7,共4页Clinical Misdiagnosis & Mistherapy

摘　　要：目的探讨主动脉夹层(aortic dissection,AD)误诊为急性心肌梗死(acute myocardial infarction,AMI)的原因并提出防范措施。方法对我院2014年1月—2017年2月收治的误诊为AMI的AD患者15例的临床资料进行回顾性分析,并复习相关文献。结果 15例主要表现为前胸痛者11例,后背痛者6例,腰痛者4例,伴面色苍白、大汗12例,伴胸闷4例。12例有高血压病史多年,7例合并动脉粥样硬化。13例心电图异常,5例心肌酶异常。初步诊断为AMI,给予对症及手术治疗。后因对症治疗效果不显进一步行相关影像学检查或术中影像学检查发现病变血管,最终确诊为AD(De BekeyⅠ型12例,Ⅱ型3例)。本组误诊时间为6 h^12 d。确诊后12例行保守治疗,3例建议行手术治疗,1例拒绝手术后死亡,余病情均稳定。结论临床医生接诊以胸痛症状并心电图ST-T改变就诊患者时,不要轻易做出AMI的诊断,应详细询问病史,仔细查体,完善D-二聚体、心肌酶检查,尽早行心脏超声或螺旋CT动脉造影等影像学检查,综合分析病情,减少误诊误治的发生。Objective To investigate the clinical characteristics and causes of misdiagnosis of aortic dissection(AD)as acute myocardial infarction(AMI),and to put forward preventive measures.Methods Clinical data of 15 patients with AD misdiagnosed as AMI in our hospital from January 2014 to February 2017 were retrospectively analyzed.Results 15 cases,there were anterior chest pain in 11 cases,back pain in 6,and low back pain in 4,accompanied by pale and sweating in 12 cases,and chest tightness in 4.Twelve cases had a history of hypertension for years,and 7 had hypertension with atherosclerosis.In addition,there were 13 cases with abnormal ECG and 5 with abnormal myocardial enzymes.The initial diagnosis was AMI,therefore,symptomatic and surgical treatment was given.Given unsatisfactory effect,further imaging examination or intraoperative imaging examination were performed,which revealed the lesion vessels,and they were finally diagnosed as AD(12 with Debekery typeⅠ,and 3 with typeⅡ).Duration of misdiagnosis was 6 h to 12 d.Twelve patients were treated conservatively after the diagnosis,3 underwent surgery,and 1 died after rejecting surgery.Conclusion In terms of patients with chest pain and change of ST-T on ECG,diagnosis of AMI should not be made hastily.A detailed history and careful physical examination are necessary,and D-dimer and myocardial enzyme examination should be improved.Timely imaging examinations including cardiac ultrasound or spiral CTA,as well as comprehensive analysis,help to reduce the incidence of misdiagnosis and mistreatment.

关 键 词：主动脉夹层 误诊 心肌梗死 

分 类 号：R543.16[医药卫生—心血管疾病]