社区诊疗糖尿病合并急性心肌梗死临床体会

CLINICAL EXPERIENCE OF DIAGNOSIS AND TREATMENT OF DIABETES MELLITUS COMBINED ACUTE MYOCARDIAL INFARCTION IN THE COMMUNITY

目的:探讨基层社区如何加强诊断和治疗糖尿病(DM)合并急性心肌梗死(AMI)。方法:对我社区2003年4月-2011年3月诊治的DM合并AMI患者40例(DM组),与同期非DM的AMI患者60例的临床资料进行对比分析。结果:DM组60.0%的患者AMI症状不典型,胸前区无明显疼痛,症状、体征多样化,心律失常、心力衰竭及休克等并发症多。DM组5例在社区进行溶栓治疗,无死亡病例;其余35例转入住院部住院治疗,死亡10例。结论:DM合并AMI患者病情较重,症状复杂,预后较差。社区是诊疗DM合并AMI的第一道屏障,在社区应早期发现确诊,尽早治疗至关重要。

Objective：To investigate how to strengthen diagnosis and treatment of diabetes mellitus（DM） combined acute myocardial infarction（AMI） in the community.Methods：From 2003.4 to 2011.3,the clinical data of 40 cases DM combined AMI（DM group） and 60 cases non-DM AMI were comparatively analyzed.Results：60% DM combined AMI showed atypical symptoms and had no obvious pain at anteriorpectorial region;the symptoms and sings of DM combined AMI were variegated. Moreover,the incidence of complications,such as arrhythmia,heart failure and shock,of DM group were obviously higher. 5 cases in DM group were treated with thrombolytic therapy in the community and no 1 case died;the other 35 cases in DM group were transferred to inpatient department,and 10 cases died. Conclusions：The pathogenetic condition of DM combined AMI is fairly serious,symptoms is complicated,an the prognosis is worse. Community is the first barrier to diagnose and treat DM combined AMI.The key point is early discovery,early diagnosis and early treatment.