以上腹痛为首发症状的急性心肌梗死23例误诊分析

Misdiagnosis Analysis of 23 Cases of Acute Myocardial Infarction with Upper Abdominal Pain as the Initial Symptom

目的探讨以上腹痛为首发症状的急性心肌梗死的误诊原因及防范措施。方法回顾性分析曾误诊的以上腹痛为首发症状的急性心肌梗死23例的临床资料。结果本组误诊率为13.69%。23例均以上腹痛为首发症状。上腹痛伴恶心、呕吐12例,伴呼吸困难5例,伴剑突下压痛6例;胀痛6例,刺痛10例,绞痛7例。就诊初期误诊为急性胆囊炎9例,急性胃炎6例,急性胃溃疡4例,胆结石3例,急性胆囊炎合并胆结石1例。误诊时间5 h^1 d。23例按误诊疾病给予相应治疗,病情皆未见明显改善。后均经进一步行心肌酶及心电图等检查确诊为急性心肌梗死,其中前壁4例、下壁16例、正后壁3例。确诊后2例抢救无效死亡;16例行冠状动脉介入治疗,5例给予尿激酶溶栓治疗,均病情缓解出院。21例出院后随访1~3个月,随访期间1例无明显原因猝死;4例未规律服药,其中2例3个月后再发急性心肌梗死入院治疗;余16例病情稳定,均未出现复发等情况。结论急性心肌梗死患者以上腹痛为首发症状时易误诊。临床医生应加强对急性心肌梗死不典型表现的警惕性和该病相关知识的认知,以减少或避免急性心肌梗死误诊误治。

Objective To investigate the misdiagnosis causes and preventive measures of acute myocardial infarction(AMI)with abdominal pain as the initial symptom.Methods The clinical data of 23 misdiagnosed AMI patients with abdominal pain as the initial symptom were retrospectively analyzed.Results The misdiagnosis rate in this group was 13.69%.Twenty-three cases all had abdominal pain as initial symptoms.Of them,12 cases had abdominal pain associated with nausea and vomiting,5 had dyspnea,and 6 had tenderness beneath the xiphoid process;there were 6 patients with swelling pain,10 with stabbing pain,and 7 with angina.At the beginning of the visit,9 cases were misdiagnosed as acute cholecystitis,6 as acute gastritis,4 as acute gastric ulcer,3 as gallstones,and 1 as acute cholecystitis complicated with gallstones.The duration of misdiagnosis was 5 h-1 d.After the symptomatic treatment according to misdiagnosed diseases,no obvious improvement was observed in all 23 patients.All the patients were diagnosed with AMI by further examination of myocardial enzyme and electrocardiogram.Among them,there were 4 cases with anterior wall AMI,16 with inferior wall AMI,and 3 with posterior wall AMI.After the diagnosis,2 cases failed to be rescued,16 underwent coronary intervention,and 5 received thrombolytic therapy with urokinase.All patients were discharged after their conditions were relieved.All 21 patients were followed up for 1 to 3 months after discharge.During the follow-up period,there was one sudden death without any apparent cause.Moreover,four patients did not take the drug regularly and two of them were hospitalized for AMI after 3 months.The remaining 16 patients had good prognosis and no recurrence was reported.Conclusion Patients suffering AMI with abdominal pain as the initial symptom are often misdiagnosed.Clinicians should strengthen the awareness of the atypical manifestations of AMI and the knowledge of the disease,thereby reducing or avoiding misdiagnosis and mistreatment.