急诊胸痛的病因学调查与分析  

Survey and analysis of etiologies for patients with chest pain and those with coronary heart disease in ER of some hospital

作　　者：耿涛 薛军 胡大一[3] 王佳 张晓雨 GENG Tao;XUE Jun;HU Da-yi;WANG Jia;ZHANG Xiao-yu(Cadre Medical and Geriatrics Department,Emergency General Hospital,Beijing 100028,China;Echocardiography Room,Emergency General Hospital,Beijing 100028,China;Heart Diseases Center Peking University People's Hospital,Beijing 100044,China;Department of Epidemiology and Health Statistics,School of Public Health,Capital Medical University,Beijing 100069,China)

机构地区：[1]应急总医院干部医疗及老年医学科,北京市100028 [2]应急总医院超声心动图室,北京市100028 [3]北京大学人民医院心脏中心 [4]首都医科大学公共卫生学院流行病与卫生统计学系

出　　处：《中国心血管病研究》2021年第2期117-121,共5页Chinese Journal of Cardiovascular Research

基　　金：北京市科技计划课题(D0905002040511)。

摘　　要：目的探讨急诊内科胸痛患者就医途径和病因学构成和相关辅助检查完善情况,为进一步制定合理的诊治方案提供依据。方法收集2017年8月至2019年8月因胸痛及胸痛等同症状至应急总医院急诊内科就诊的患者。使用统一表格记录人选患者的一般资料、既往病史、发病时间、到达急诊时间、胸痛特点实验室检查、心电图诊断及影像学结果,初步诊断和急诊的治疗情况,确定诊断和心血管不良事件。所有数据经SPSS25.0统计软件进行统计学处理。结果胸痛患者就医的主要方式为自行前往医院(84.7%),但急性心肌梗死患者以救护车转运的比例(38.6%)高于其他原因胸痛患者(14.7%)。非心源性胸痛(共537例)占胸痛病因比例较高(46.5%),心源性胸痛的主要原因为冠心病(共351例)(30.4%)。冠心病患者疼痛部位中位于胸骨后的患者为152例,位于左侧胸部的患者数量为138例,与非冠心病患者相同疼痛部位的患者数量比较均有统计学意义(P<0.001)。一些常用的急诊铺助检查在急诊胸痛患者中完成程度好,并且表明适用于冠心病的诊断及鉴别诊断中(P>0.05)。结论急诊胸痛患者院前转运和急诊室检查评估均应以科学的研究结果为依据,这不仅可以减少疾病危险性和降低漏诊误诊率,同时能够使患者得到科学的治疗,从而降低病死率和并发症的发生。Objective To explore the way of seeking medical treatment and etiological composition of patients with chest pain and the improvement of relevant auxiliary examinations and provide the basis for making reasonable diagnoses and treatment plans.Methods Select the emergency room(ER)patients with chest pain or equivalent syndrome in Emergency General Hospital from August 2017 to August 2019.A total of 1156 patients were enrolled in the study.Among them,633 were males and 523 females,which separately accounts for 55%and 45%of the total participants.The data(medical history,onset time,arrival time of emergency,chest pain characteristics,laboratory examinations,electrocardiograph(ECG)diagnosis and imaging results,preliminary diagnosis and treatments,determination of diagnosis and cardiovascular adverse events)were collected by unifted forms.All the data were processed by the software SPSS 25.0.Results The main way for patients with chest pain was to go to hospital by themselves(84.7%),but the proportion of patients with acute myocardial infarction transferred by ambulance(38.6%)was higher than that of patients with other causes of chest pain(14.7%).Patients with non-cardiogenic chest pain were 537 which accounted for 46.5%of the causes of chest pain and the patients with CHD were 351(30.4%).Among the CHD patients,152 were located in the posterior sternum and 138 were located in the left chest,which were statistically significant compared with the patients without CHD in the same pain sites(P<0.001).Some commonly used emergency auxiliary examinations were well completed in the emergency chest pain patients and showed that they were suitable for the diagnosis and differential diagnosis of coronary heart disease(P>0.05).Conclusion Pre-hospital transfer and emergency room examination evaluation of emergency chest pain patients should be based on scientific research results,which can not only reduce the risk and reduce the misdiagnosis rate,but also can get scientific treatment,so as to reduce the mortality and complications

关 键 词：胸痛 病因学 冠状动脉疾病 

分 类 号：R541.4[医药卫生—心血管疾病]