以消化系统症状为首发表现的急性心肌梗塞临床误诊分析

Clininal Analysis for Misdiagnosis of Acute Myocardical Infarction with the Initiation Symptom of Digestive System

目的探讨以消化系统症状为首发表现的急性心肌梗塞的临床特点,以减少误诊、漏诊,提高诊治水平,减少死亡率。方法对2005年～2008年我院74例患者以消化系统症状为首发表现的急性心肌梗塞临床特点、心电图改变、发病诱因等进行回顾性分析。结果临床表现主要以腹痛(94.59%)、呕吐(79.73%)、恶心(44.5%)为主,其次为腹泻(6.76%)、腹胀(8.1%)、大汗淋漓(6.76%);心电图示心肌梗塞部位为:下壁(78.38%),前壁(9.46%),广泛前壁(4.05%),多壁(2.70%),心内膜下(5.40%);发病诱因在青年组以吸烟饮酒为主,中老年组发病时有54.35%患者是无诱因的。结论临床医生应对中老年人及青年人高危人群中以消化系统为首发表现的急性心肌梗塞要有足够的认识和警惕,如相应疾病治疗后症状不能缓解者,要及时做常规心电图及心肌酶检查、肌钙蛋白,以减少误诊率和降低死亡率,提高诊疗水平。

Objective To investigate the clinical manifestations of acute myocardial infarction with the initiation symptom of digestive system, so as to decrease the rate of misdiagnosis and mortality. Methods Seventy-four patients of acute myocardial infarction with the initiation symptom of digestive system admitted in our hospital from 2005 to 2008 were analyzed retrospectively, including the information of clinical manifestation, electrocardiogram （ECG） results and risk facts. Results The main clinical manifestations of selected cases included stomachache in 94.59% of patients; vomiting in 79.73% of patients; nausea in 44.5% of patients; abdominal distention in 8.1% of patients; diarrhea and sweating in 6.76% of patients respectively. ECG results demostrated that the location of myocaridal infarction included inferior wall in 78.38% of patients; anterior wall in 9.46% of patients; extensive anterior wall in 4.05%; more than one wall in 2.70% of patients; subendocardial infarction in 5.40% of patients. Risk factors were smoking and drinking in the young group, while no specifical risk factors were found in 54.35% of old patients. Conclusion Clinicians should increase the awareness of this group of patients with high risks of acute myocardial infarction with the initiation symptom of digestive system. For decreasing the rate of misdiagnosis and mortality, it＇s necessary to perform ECG and to take myocardial enzymes and troponin tests promptly when digestive symptoms can＇t be alleviated by corresponding treatments.