非典型急性心肌梗死患者的早期诊断及急诊处理分析

The Typical Acute Myocardial Infarction Patients Early Diagnosis and Emergency Treatment Analysis

目的探讨非典型急性心肌梗死患者早期诊断方法及急诊处理对策。方法对我院2009年1月至2011年12月期间诊治的42例非典型心肌梗死患者病例资料进行回顾性分析。结果有11例在入院后初诊误诊,误诊率26.19%,其中误诊为胃炎者3例,急性心功能衰竭2例,急性胆囊炎1例,急性肠炎1例,心律失常3例,心源性休克1例。心电图检查定位心肌梗死部位,其中前壁占30.95%,前间壁,占21.43%,心内膜下占16.67%,广泛前壁占14.29%,侧壁占9.52%,后壁占7.14%。以速率法检测心肌酶,CK为(532.27±73.28)U/L,CK-MB为(94.23±26.42)U/L,LDH为(632±127.38)U/L,AST为(125.42±26.36)U/L,均升高与正常参考值2倍以上。经过积极治疗,18例患者最终痊愈,痊愈率42.86%,21例患者好转,好转率50.00%,3例死亡,病死率7.14%3。结论早期行心电图及心肌酶检查有助于协助非典型急性心肌梗死的早期诊断,及时恰当的急诊处理能减少心肌受损,提高治愈率,改善患者预后。

Objective to explore the typical patients with acute myocardial infarction early diagnostic methods and emergency treatment countermeasures.Methods clinical data of January 2009-December 2011 of the 42 patients with diagnosis and treatment during atypical myocardial infarction cases were analyzed retrospectively.Results the have 11 cases in both the misdiagnosis after admission,the misdiagnosis rate was 26.19%,among which the misdiagnosis of gastritis in 3,2 cases of acute cardiac failure,acute cholecystitis in 1,1 case of acute enteritis,arrhythmia in 3,cardiac shock in 1.Ecg positioning myocardial infarction parts,including former wall accounted for 30.95%,former JianBi,21.43%,a subendocardial 16.67%,wide front wall is 14.29%,9.52% lateral wall,accounted for 7.14%.To rate method to detect cardiac enzyme,CK for（532.27 ±73.28）U/L,CK-MB for（94.23 ±26.42）U/L,LDH for（632 ±127.38） U/L,AST for（125.42 ±26.36）U/L,all rise and normal reference value more than two times.After treated actively,18 cases of patients with the final heal,recovery rate was 42.86%,21 patients get better,the recovery 50.00%,3 cases of death,and mortality was 7.14% 3.Conclusion early line electrocardiogram and myocardial enzymes to help check the typical in the early diagnosis of acute myocardial infarction,proper emergency treatment in time to reduce heart damage,enhance the curative rate and improve the prognosis of patients with.