急性腹痛就诊的急性心梗的治疗体会

The Experience in Treatment of Acute Myocardial Infarction with Acute Abdominal Pain

目的分析以急性腹痛就诊的急性心肌梗死的治疗情况。方法选取我院2012年1月至2014年12月急诊收治的AMI患者40例,患者均以急性腹痛为首发症状,表现为上腹部疼痛者25例,右上腹部疼痛着7例,坐上腹部疼痛者6例,右下腹部疼痛者2例。常规心电图检查、肌钙蛋白及心肌酶学检测,经B超或CT排除其他疾病后确诊。有溶栓指征者给予溶栓治疗,并给予常规的抗血小板、抗凝及调脂治疗,右室梗死者给予补液、扩容及升压治疗。不同意溶栓者给予扩冠、抗凝等常规治疗。结果溶栓治疗后患者腹痛消失,心电图检查ST回落,磷酸肌酸激酶酶峰提前出线,并出现再灌注心律失常时判断溶栓成功。静脉溶栓再通率81.5%,冠状动脉内溶栓再通率92.4%,因心律失常死亡2例。结论对于以腹痛为症状高度怀疑AMI的患者,应尽早行相关检查,排除可能疾病并及时救治。

Objective Analysis for the treatment of acute abdominal pain in patients with acute myocardial infarction cases. Methods 4（1 patients with AMI in our hospital from 2012 January to 2014 selected in December admitted to emergency cases, thrombolytic indications given thrombolysis, antiplatelet, anticoagulation and give and lipid treatment routine, right ventricular infarction patients given fluid, expansion and boost therapy. Don＇t agree with thrombolytic, anticoagulant given conventional treatnaent such as crown expansion. Results Venous thromholytic recanalization rate of 81.5%, in the coronary artery recanalization rate of 92.4%, 2 cases of death due to arrhythmia. Conclusion For abdominal pain symptoms of suspected AMI patients, should he done as early as possible the relevant examination, rule out the possibility of disease and timely treatment.