外科急诊中以腹痛为主诉的老年急性心肌梗死23例临床分析

Acute myocardial infarction in elderly patients complained of abdominal pain in surgery emergency:clinical analysis of 23 cases

目的探讨以腹痛于外科急诊的老年急性心肌梗死(AMI)患者的临床特征,以减少误诊。方法回顾性分析23例以腹痛于外科急诊的老年AMI患者的临床资料,并选取同期以腹痛急诊于内科的老年AMI患者30例和以腹痛急诊于外科的老年急腹症患者40例作对照组。结果急诊于外科的老年AMI组有冠心病危险因素史比率高于外科急腹症组,伴胸闷占43.4%、心悸17.4%、心前区不适感者30.4%,均高于外科急腹症组(P值分别为0.005、0.035、0.005);有外科腹痛史者高于内科急诊组(56.5%vs 26.7%,P=0.028);伴恶心、呕吐占60.9%,症状重,但腹部阳性体征少,心电图表现Ⅱ、Ⅲ、avF多见,常合并V7～V9改变;有就诊心电图记录者占78.3%,高于外科急腹症组、但低于内科急诊组(P值0.036、0.027);行腹B超、立位腹平片检查高于就诊于内科组(52.2%,26.1%;P值0.006、0.015)。结论以腹痛急诊于外科的老年AMI患者有其临床特征,详细询问病史、认真查体、及时查心电图是避免延误治疗的关键。

Objective To explore the clinical characteristics of elderly acute myocardial infarction（AMI） in surgery emergency because of abdominal pain, in order to decrease misdiagnosis. Methods Retrospective analysis of clinical data of 23 elderly AMI cases in surgery emergency because of abdominal pain were carried out. Thirty cases admitted to the medical department and 40 cases admitted to the surgical department because of abdominal pain were selected as controls. Results In surgery emergency patients, the rate of history of coronary heart disease risk factor was higher than that in surgerical acute abdomen patients. They had chest distress in 43.4%, palpitation in 17.4%, precordial discomfort in 30.4%, which were higher than the incidences in surgical acute abdomen group（P= 0. 005, 0. 035,0. 005）. They also had higher incidence of surgerical abdominal pain than that in medical emergency group （56. 5% vs 26. 7% ,P=0. 028）. They had nausea and vomiting in 60.9% with severe symptoms, but usually few ab- domen physical sign. They had changes of electrocardiogram in Ⅱ, Ⅲ, avF, usually complicated with V7-V9 changes. They had electrocardiogram record immediately in 78.3%, which was higher than surgical acute abdomen group, but lower than medical emergency group （P=0.036,0.027） ; For the patients with normal electrocardiogram （ECG） on admission, ECG reexamination was performed. More abdomen B ultrasound and erect position abdomen X-ray examinations were performed for these cases than for patients of medical emergency group（52.2%, 26.1%; P=0.006, 0. 015）. Conclusion Elderly AMI patients in surgery emergency because of abdominal pain have their clinical characteristics. In order to avoid misoliagnosis surgeons in emergency department should collect case history in detail, perform physical examination carefully and examine ECG in time.