256例急性心肌梗死临床特点分析

Clinical characteristics analysis of 256 cases with acute myocardial infarction

目的:了解急性心肌梗死(AMI)的非典型临床表现,以期提高早期诊断,减少漏、误诊率及降低死亡率。方法:对256例AMI患者进行回顾性总结分析。结果:非典型AMI患者共72例(28.1%);与典型AMI患者相比,非典型患者年龄高(69.8岁︰58.5岁,P<0.01),女性比例高(43.1%︰30.4%,P<0.01),伴发糖尿病(33.3%︰23.9%,P<0.01)和心力衰竭(20.8%︰13.6%,P<0.01)比例高,住院期间死亡率高(33.3%︰5.2%,P<0.01),平均就诊时间显著延迟(24.5h︰9.8h,P<0.01),入院时确诊率显著降低(20.6%︰53.4%,P<0.01)。结论:AMI的非典型临床表现相当普遍,导致较高的漏、误诊率,且住院期间病死率显著增加,早期识别能有效提高确诊率,对改善预后有极其重要的意义。

Objective：To explore the atypical clinical manifestations of acute myocardial infarction （AMI）, for improving the early diagnosis and reducing the false negative, false positive and fatality rate. Method：Two hundred and fifty-six patients with AMI were chosen to go through the retrospective summary and analysis. Result： There were 72 patients with atypical AMI, and the prevalence rate was 28. 1~. Compared with the typical patients, the atypical patients were characterized with old age （69.8 vs 58.5, P〈0.01）, higher percentage of women patients （43.1% vs 30.4%, P（0.01）, combined higher percentage of diabetes history （33.3% vs 23.9%, P〈0.01） and cardiac failure history （20.8% vs 13.6%, P〈0.01） and higher in-hospital mortality （33.30% vs 5.2%, P〈 0.01）. The average treatment time of the atypical patients was significantly delayed （24.5 h vs 9.8 h, P〈0.01） and the correct diagnose rate on admission was significantly decreased （20.6 % vs 53.4%, P〈0.01）. Conclusion： The atypical clinical manifestation of AMI is fairly common and results in higher false negative and positive rates. Moreover, the in-hospital fatality rate of patients with atypical AMI significantly increases. Therefore, early identification can effectively improve the correct diagnosis rate, which is important significance to the prognosis improvement.