胸痛的急诊思维

Emergency treatment thinking on chest pain

目的浅要探析胸痛急诊处理思维模式。方法选取2010年5月—2011年8月急诊科收治的以胸痛为主诉就诊的184例患者的临床资料,总结分析。结果 184例患者中,心源性胸痛125例,占67.9%,其中心绞痛93例,心肌梗死19例,心肌炎10例,心包炎3例。非心源性胸痛59例,占32.1%,支气管肺炎21例,食管源性疾病16例,肋间神经痛4例,肋间软骨炎4例,带状疱疹5例,胃癌2例,主动脉夹层动脉瘤2例,胸膜炎1例。心源性胸痛发病高于非心源性胸痛发病率,对比差异有统计学意义(P<0.05)。结论胸痛患者急诊时应先做出辨证诊断然后给予合适治疗,以最大限度的降低漏诊误诊率。辨证、清晰、有效的思维模式是患者预后的重要保障。

Objective a brief discussion on the emergency treatment thinking on chest pain. Methods Selecting clinical data of 184 cases of patients with chest pain as chief complaint who were received and cured in the emergency department from May, 2010 to August 2011 and summarizing and analyzing them. Results Among the 184 cases of patients, there are 125 cases with chest pain of cardiac origin, accounting for 67.9%, in which there are 93 cases of stenocardia, 19 cases of myocardial infarction, 10 cases of myocarditis, 3 cases of pericarditis. Chest pain of non-cardiac origin takes 59 cases, accounting for 32.1%, in which there are 21 cases of bronchial pneumonia, 16 cases of diseases with esophagus origin, 4 cases ofintercostal neuralgia, 4 cases ofintercostal chondritis, 5 cases of herpes zoster, 2 cases of gastric cancer, 2 cases of aortic dissecting aneurysm and 1 case of pleuritis. The incidence rate for chest pain of cardiac origin is higher than that of chest pain of non-cardiac origin and the contrast difference is of statistical significance（P〈0.05）. Conclusion In case of the emergency treatment, for the chest pain patients , they shall be given dialectical giagnosis first and then appropriate treatment, reducing missed diagnosis and misdiagnosis rate to the uttermost. A dialectical, clear and effective thinking model is the important prognostic guarantee for the patients.