354例急诊不典型心肌梗死患者快速识别方法和要点探讨

A Rapid Identification Method and Essentials of 354 Patients with Emergency Atypical Myocardial Infarction

目的探讨急诊不典型心肌梗死患者的快速识别方法,以免延误最佳治疗时机。方法回顾分析2012年6月至2015年12月我院急诊救治的354例初诊不典型急性心肌梗死(AMI)患者的临床资料,对患者自述情况、病史、心电图检查及其他辅助检查结果进行统计,筛选出9个可能对诊断有影响的因素:年龄、性别、体质指数、饮酒、吸烟、首次诊断时间、合并其他疾病、医师专业程度、梗死部位。对这9个因素进行误诊率单因素分析,并进一步进行非条件logistic多因素回归分析。结果 354例患者中由于症状不典型早期误诊39例,误诊率为11.02%;单因素和多因素分析结果显示,年龄、合并其他疾病、医师水平、首诊时间、发生心肌梗死部位均显著影响诊断准确率。结论不典型AMI诊断应该进行全面诊断、综合分析,对于疑似患者,行包括心电图、血液生化检查、询问病史等检查,对符合以上高误诊因素的患者应重点观察和诊断,随时关注其病情变化,请其他科室专家协助进行诊断。

Objective To explore the rapid identification of patients with acute atypical myocardial infarction in order to avoid the best time to delay treatment.Methods From June 1,2012-December 31,2015,clinical data of 354 patients with newly diagnosed acute myocardial infarction（AMI） in our hospital were retrospectively analyzed,the patient＇s history,clinical symptoms,electrocardiogram,lifestyle and other data were statistically analyzed.Patient age,the first diagnosis time,the factors such as age,first diagnosis time,physician＇ s professional degree,infarct site,combined with other diseases and other factors misdiagnosis rate were analyzed using card single factor analysis,on this basis,LOGistC.multivariate regression analysis was performed on five factors that might affect the diagnostic accuracy.Results Of the354 patients,39 were misdiagnosed by atypical symptoms,and the misdiagnosis rate was 11.02%;According to the results of single factor and multivariate analysis,age,combined with other diseases,physician level,the first visit time and the occurrence of myocardial infarction were significantly affected by the diagnostic accuracy,the difference were statistically significant（P〈0.05）.Conclusion Atypical acute myocardial infarction in patients with early clinical symptoms is diverse,the diagnosis should be base on the mastery of comprehensive information,including understanding of patients with history,clinical symptoms,ECG performance,line myocardial enzyme examination,in order to carry out emergency treatment as soon as possible,so as to reduce the infarct size and myocardial damage,thereby enhancing the efficacy and improve the prognosis of patients.