无典型症状老年冠心病七例误诊报告

Misdiagnosis Analysis of 7 Elderly Patients with Asymptomatic Coronary Heart Disease

目的探讨老年冠心病临床特点、误诊原因及防范措施。方法对2015年1月—2016年3月乐山市人民医院收治的曾误诊的7例无典型症状老年冠心病的临床资料进行回顾性分析。结果本组7例,误诊率8.75%,年龄(68.5±5.08)岁,因颈部及后背部疼痛误诊为颈椎病1例,因反复心前区不适伴憋气误诊为心脏神经官能症2例,因饮食不当出现腹胀、上腹痛、恶心、呕吐并喘憋不适误诊为胃肠炎1例,因咽部不适、发紧、咳嗽及咳痰误诊为上呼吸道感染3例。本组误诊时间8 h^2 d。后经心电图或冠状动脉造影检查等均确诊为冠心病,6例予强化抗血栓、扩张冠状动脉、抗血小板、改善心功能、控制血压和心率等对症支持治疗病情好转;1例予心脏搭桥手术,术后恢复良好出院。结论因老年患者常有多种慢性疾病,且老年冠心病常症状不典型,加之部分接诊医师知识面狭窄、诊断思维局限,易导致老年冠心病误诊。临床接诊此类患者时需详细病史询问、认真查体、仔细鉴别诊断并全面综合分析病情,以减少或避免无典型症状老年冠心病误诊误治。

Objective To investigate clinical characteristics, causes of misdiagnosis and treatment, and prevention methods for elderly patients with coronary heart disease. Methods Clinical data of 7 misdiagnosed elderly patients with asymptomatic coronary heart disease admitted during January 2015 and March 2016 was retrospectively analyzed. Results A- mong the 7 patients with （68.5 -＋5.08） years o/d, the misdiagnosed rate was 8.75% , among whom 1 patient was misdiag- nosed as having cervical spondylosis because of pain in neck and back; 2 patients were misdiagnosed as having cardiasthenia due to repeated preeordial discomfort and breathlessness; 1 patient was misdiagnosed as having gastroenteritis due to abdominal distention, upper abdominal pain, nausea, vomiting and wheezing discomfort induced by improper diet; 3 patients were misdi- agnosed as respiratory infection due to throat discomfort and tightness, cough and sputum. The misdiagnosed time of the 7 pa- tients was 8 h-2 d, and coronary heart disease was confirmed after further examinations such as electrocardiogram or coronary angiography. Symptomatic treatments such as strengthening anti-thrombus, coronary artery dilatation, anti-platelet, heart func- tion improvement, controlling blood pressure and heart rate were performed in 6 patients, and then patients＇conditions improved; other 1 patient underwent bypass surgery, and then was discharged after well recovery. Conclusion Elderly patients with asymptomatic coronary heart disease are easily misdiagnosed because of combination of many chronic illness, unrepresentative symptoms, lack of knowledge and understanding in clinicians. Clinicians should carefully ask, check, give differential diagnosis and comprehensively analyze conditions of the elderly patients in order to avoid misdiagnosis and mistreatment.