“误诊疾病数据库”单病种误诊文献研究:应激性心肌病

A Study on Misdiagnosis Literature of Single Disease of Chinese Misdiagnosed Disease Database: Stress Induced Cardiomyopathy

应激性心肌病(stress induced cardiomyopathy,SCM)是一种与精神或躯体应激相关的暂时性以左室心尖部室壁运动功能异常为表现的心脏病,因其临床表现与急性冠状动脉综合征相似,许多临床医师对其缺乏认识,易导致误诊误治。2004—2013年发表在中文医学期刊并经遴选纳入"误诊疾病数据库"的SCM文献共28篇,纳入误诊病例114例,28篇文献均未涉及误诊率。误诊疾病居前3位的是急性心肌梗死、不包括急性心肌梗死在内的其他急性冠状动脉综合征和急性心肌炎。对误诊后果的分析显示,114例误诊后果均为Ⅲ级,即发生误诊误治未造成不良后果。首位误诊原因为缺乏特异性症状和体征,其次为经验不足、缺乏对该病认识以及未选择特异性检查项目。提示临床工作中在对急性胸痛进行鉴别诊断时,应拓展思维,在鉴别急性心肌梗死、急性肺栓塞、急性主动脉夹层破裂及张力性气胸等疾病时,还要考虑到SCM可能;虽然SCM临床预后良好,但急性冠状动脉综合征的预后则不同,故临床接诊酷似急性心肌梗死的患者时,在未确诊前应先按照急性冠状动脉综合征处理和监护,但药物治疗禁用β受体激动剂和儿茶酚胺类正性肌力药物。

Stress induced cardiomyopathy（ SCM） is a recently recognized form of transient left ventricular apical hypokinesis that is presumably precipitated by stress and may clinically resemble an acute coronary syndrome（ ACS）,and is prone to be misdiagnosed. Twenty-eight literatures of misdiagnosis SCM were selected from enrolled misdiagnosis disease database,published in Chinese medical journals during 2004 and 2013. The enrolled misdiagnosed cases were 114 patients and no misdiagnosis rate was mentioned. Among the misdiagnosed diseases,the top three were acute myocardial infarction,ACS（ acute myocardial infarction excluded） and acute myocarditis. The misdiagnosis result showed no obvious adverse sequel in 114cases（ grade Ⅲ misdiagnosis result）. The first misdiagnosis cause was the lack of specific symptoms and signs. And the second was inadequate clinical experience of physicians who lacked the knowledge about the SCM and ignored the specific tests.Clinical physicians should enrich the knowledge about the acute myocardial infarction,acute pulmonary embolism,acute aortic dissection,tension pneumothorax and SCM. Although SCM patients do not suffer permanent myocardial damage as the ACS disease,the suspected SCM cases should be treated as the ACS first with the β-receptor agonists and catecholamine is forbidden.