急诊科医师对心电图ST段抬高胸痛患者的误诊

Emergency physician misdiagnosis of ST-segment elevation electrocardiogram in Emergency Department Chest Pain Patients

目的通过分析ST段抬高心电图胸痛患者在急诊科的误诊,发现急诊科诊疗流程、水平的缺陷,为提高改善提供依据。方法对来急诊科就诊的142例ST段抬高(2个以上相关肢体导联ST段抬高﹥1mm,或2个以上相关胸前导联﹥2mm)的胸痛患者,在心肌酶化验及其他检查结果出来之前,将急诊科医师和心内科会诊医师各自所做的心电图诊断和最终的临床诊断进行比较,统计二者的误诊率,用Fisher确切概率法卡方检验二者是否有统计学意义,分析误诊原因。结果急诊科医师的误诊率明显高于心内科医师。结论急诊科医师经验不足、对心电图不精以及急诊科软硬件环境等是产生误诊的因素。足够的心电图知识培训,和及时请求会诊是避免产生误诊的途径。

Objective To determine the rate of error in emergency physician（EP） interpretation of the cause of electrocardiographic（ECG） ST-segment ele-vation（STE） in adult chest pain patients. Methods conducted a retrospective ECG review of 142 adult chest pain patients in Bao Gang hospital emergency department（ED） over a year pe-riod（Jan 2014 to Dec 2015）. ST-segment ele-vation was determined to be present if the ST segment was elevated 1 mm in the limb leads and 2 mm in the precordial leads in at least two leads. Initial EP ECG interpretation was compared with the final interpretation by a cardiologist supported, variables were compared by the Fisher exact test. The rate of incorrect ECG diagnosis was calculated. Results The rate of ECG STE misinterpretation of DP is more than cardiologist. Conclusions Emergency physicians show lack of experiences,inadequae knowledge on STE.