96 例不典型急性心梗临床误诊的原因及预防措施
田静
（周至县中医医院，陕西 西安，710400）
浏览次数：75次 下载次数：356次
摘要：
目的 分析不典型急性心梗诊断中产生误诊的原因，并以此提出预防措施，提升临床诊断准确率。方法 本研究对象为我院在2013年3月至2016年3月收治的96例不典型急性心梗临床误诊患者，回顾性分析所有患者的临床资料，总结误诊原因。结果 96 例不典型急性心梗分别误诊为21 例急性胃炎，9 例急性胆囊炎，15例急性胃肠炎，9例高血压合并心律失常，6例胆石症慢性胆囊炎，6例急性支气管炎，6例肺部感染并心力衰竭，9 例脑梗死，6 例牙龈炎，3 例糖尿病酮症酸中毒昏迷， 6 例下颌痛。确诊为急性心梗之后，针对患者的实际情况，予以相应的治疗后，好转94 例，2例死亡，死亡原因为心源性休克。 结论 不典型急性心梗常误诊为急性胃炎、急性胆囊炎、急性胃肠炎、高血压合并心律失常等，做好患者的全面检查、详细询问病史、动态观察心电图，检测肌钙蛋白、心肌酶等水平，可将误诊率尽最大可能降低。
关键词：不典型急性心梗；临床误诊；原因；预防措施
中图分类号：R542.22 文献标志码：A文章编号：2096-1413(2017)28-0017-02
Causes and countermeasures of clinical misdiagnosis of 96 cases of atypical acute myocardial infarction
TIAN Jing
(Zhouzhi County Hospital of Traditional Chinese Medicine, Xi``an 710400, China)
ABSTRACT: Objective To analyze the causes and countermeasures of clinical misdiagnosis of 96 cases of atypical acute myocardial infarction, and to put forward the clinical diagnosis accuracy rate of atypical acute myocardial infarction. Methods A total of 96 case of misdiagnosed patients of atypical acute myocardial infarction admitted into our hospital from March 2013 to March 2016 were selected, and their clinical data were retrospectively analyzed, and the causes of misdiagnosis were concluded. Results Of the 96 misdiagnostic cases of atypical acute myocardial infarction, there were 21 cases of acute gastritis, 9 cases of acute cholecystitis, 15 cases of acute gastroenteritis, 9 cases of hypertension combined arrhythmia, 6 cases of cholelithiasis and chronic cholecystitis, 6 cases of acute bronchitis, 6 cases of lung infection and heart failure, 9 cases of cerebral infarction, 6 cases of gingivitis, 3 cases of diabetic ketosis and acidosis, 6 cases of mandible pain. After appropriate treatments according to the actual situation of the patients, 94 cases improved, 2 cases death, the cause of death due to the cardiogenic shock. Conclusion Atypical acute myocardial infarction often misdiagnose as acute gastritis, acute cholecystitis, acute gastroenteritis, hypertension with arrhythmia and so on, comprehensive examination, detailed disease history, dynamic observation of electrocardiogram, detection the levels of troponin, myocardial enzymes can be most likely decrease the misdiagnosis.
KEYWORDS: atypical acute myocardial infarction; clinical misdiagnosis; causes; countermeasures
参考文献：
[1] 张建伟,石振东.不典型急性心梗的临床诊治分析[J].中国伤残医学,2014,22(5):106-107.
[2] 唐聚花.不典型急性心肌梗死误诊分析62例[J].中国社区医师:医学专业,2012,14(11):266.
[3] 韦利元,花冠杰,韦颖.急性心梗的非特异性临床特征与误诊原因分析[J].医学信息,2015,28(43):406.
[4] 黄静.症状不典型急性心肌梗塞的临床分析[J].医学信息,2011,24(3):1309-1310.
[5] 董辉,黄斌.腹痛型急性心肌梗死26 例误诊分析[J].中华保健医学杂志,2012,14(3):235-236.
[6] 关晖勇.不典型急性心肌梗死临床特点分析[J].医学信息,2011,24(6):2305-2306.
[7] 尹进.浅析急性心梗患者的临床特点及治疗方法[J].求医问药,2013,11(8):122.
[8] 李慧彬,代晓飞,张杰,等.急性心肌梗死46 例临床分析[J].中外医疗,2012,31(12):68.
[9] 刘双荣,刘春艳.无胸痛的院前急性心梗27 例临床表现分析[J].中国实用医药,2012,7(10):78-79.
[10] DULLAART RPF, PELT LJV,KWAKERNAAK AJ,et al.Plasma lipoprotein -associated phospholipase A2, mass is elevated in STEMI compared to non-STEMI patients but does not discriminate between myocardial infarction and non-cardiac chest pain[J].Clin Chim Acta,2013(424): 136-140.