北京市急诊胸痛的病因学调查分析

Main etiologies for patients presented to ER with chest pain or chest pain equivalent

目的探讨北京市急诊科胸痛患者的病因学构成，为确立进一步的治疗方案提供依据，降低治疗费用。方法 本研究属多中心前瞻性描述性研究，参研单位包括17所医院。使用统一表格记录入选患者的一般资料，包括既往病史，发病时间，到达医院急诊时间，胸痛特点，心电图描述及诊断，初步诊断，急诊的诊治情况，辅助检查，确定诊断和去向，就诊30d后的临床转归情况。所有数据经SAS8．2统计软件进行统计学处理。结果2009年7—8月，在17个医疗中心连续有效人选至急诊室就诊的胸痛患者，计划纳入6000例，最终5666例患者确认获得有效记录而入选，平均年龄（58．1±18．4）岁，男性2663例，占47％；女性3003例，占53％。胸痛患者占急诊总量的4．7％（5666／130553）。病因学分析结果：冠心病1509例（27．4％），急性心力衰竭149例（2．6％），心包炎4例（0．1％），肺栓塞11例（0．2％），主动脉夹层8例（0．1％），急性脑血管病431例（7．6％），非心源性胸痛2538例（44．9％）。30d随访结果：院外死亡37例（O．7％），再次入院275例（4．9％）。结论重视并认真对待胸痛患者，特别是无胸痛患者和以伴随症状就诊的患者，正确地做出诊断，及时进行规范诊疗，降低患者的病死率。

Objective To identify the main etiologies of emergency room （ER） patients with chest pain or equivalent syndrome. Methods This was a prospective and cross-sectinal survey of ER patinets with chest pain or equivalent syndrome in 17 medical centre in Beijing, China from July to August 2009. Data was collected by structured interviews and medical record reviews. The mean follow up period was 30 days. Results A total of 5666 patients were enrolled in the study （2663 males and 3303 females） and the mean age was 58. 1 ± 18.4 years. Their final diagnoses were ： coronary heart disease 1506 （ 27.4% ）, acute heart failure 149 （ 2. 6% ） , pericarditis 4 （ 0. 1% ）, pulmonary embolism 11 （ 0. 2% ）, aortic dissection 8 （ 0. 1% ）, acute cerebrovascular disease 431 （ 7. 6% ） and non-cardic chest pain 2538 （ 44. 9% ） . Thirty-seven cased died and 275 cases hospitalized again 30 days later, 4.9% patients with cornary heart disease had symptoms at their presentation. Conclusion Special vigilance and thorough coronary artery evaluation are needed for all patients with chest discomfort or respiratory distress in the ER, even for patients without chest pain.