社区获得性肺炎合并急性心肌梗死的临床特点分析

Analysis of Clinical Characteristics of Community Acquired Pneumonia Complicated with Acute Myocardial Infarction

目的探讨社区获得性肺炎（community acquired pneumonia,CAP）合并急性心肌梗死（acute myocardial infarction,AMI）的临床特点及相关机制,以减少误漏诊。方法对武警四川省总队医院2008年7月—2015年3月收治的AMI 593例,根据是否合并CAP分为CAP组（47例）和非CAP组（546例）,观察比较两组一般情况、基础疾病情况、临床表现及治疗、转归情况,并分析CAP组误漏诊情况。结果与非CAP组比较,CAP组年龄较大,合并糖尿病、陈旧性心肌梗死、慢性阻塞性肺疾病率高,胸痛发生率低,心律失常、急性左心衰竭、呼吸困难、心源性休克及消化道出血发生率高,差异均有统计学意义（P〈0.05）。CAP组19例在发生AMI后24 h内未能确诊,其中15例于发生AMI后24-48 h确诊,4例于发生AMI后48-72 h确诊,漏诊AMI 14例,误诊为COPD急性加重3例、慢性胃炎2例。19例均经相关检查及参照相关诊断标准确诊CAP合并AMI。经相应治疗后,CAP组病情好转率低于非CAP组,病死率高于非CAP组,差异具有统计学意义（P〈0.05）。结论 CAP合并AMI临床表现常不典型,易漏误诊,且病死率较高,临床医生应予重视。

Objective To explore the clinical features and related mechanisms of community acquired pneumonia （CAP） complicated with acute myocardial infarction （AMI） in order to reduce missed diagnosis and misdiagnosis rates. Methods According to complication conditions, 593 patients with AMI admitted to Sichuan Provincial Armed Police Force Hospital during July 2008 and March 2015 were divided into CAP group （n = 47） and non-CAP group （n = 546）. General conditions, comorbidities, clinical symptoms, and treatment outcomes in the two groups were compared. Missed diagnosis and misdiagnosis were analyzed in CAP group. Results Compared with non-CAP group, CAP group had older age, higher incidence rate of comorbidities （including diabetes, old myocardial infarction, chronic obstructive pulmonary disease） , lower in- cidence rate of chest pain, and higher incidence rate of arrhythmia, acute left ventricular failure, dyspnea, cardiogenic shock, and gastrointestinal bleeding. The difference was statistically significant （ P 〈 0.05）. 19 patients of CAP group were not diagnosed within 24 hours after AMI occurred, and 15 patients were diagnosed within 24-48 hours, 4 patients were diagnosed within 48-72 hours. Among them, 14 patients were miss diagnosed, 3 patients were misdiagnosed with acute exacerbation of chro- nic obstructive pulmonary disease, and 2 patients were misdiagnosed with chronic gastritis. The 19 patients were finally diag- nosed with CAP complicated with AMI according to relative diagnostic criteria after related examinations. After corresponding relative treatment, improvement rate in CAP group was lower, and fatality rate was higher than that in non-CAP group. Differences were statistically significant （ P 〈 0. 05 ）. Conclusion Clinical syndromes of AMI complicated with CAP is usually atypical, with high rates of missed diagnosis, misdiagnosis, and fatality.