不典型症状急性心肌梗死52例临床特点分析

Analysis of clinical features of 52 patients with atypical symptoms of acute myocardial infarction

目的对不典型症状急性心肌梗死和典型胸痛急性心肌梗死病人的临床特征以及治疗和预后进行观察。方法回顾性选择2016年6月至2018年5月上海交通大学医学院附属第九人民医院收治的急性心肌梗死病人共202例,其中不典型症状心肌梗死52例,有典型胸痛心肌梗死150例,对两组病人进行临床特征观察比较。结果与典型胸痛急性心肌梗死组比较,不典型症状急性心肌梗死组发病年龄较大[(75.6±13.2)岁比(65.2±12.1)岁,P<0.05],女性(28.8%比18.7%,P<0.05)及伴有糖尿病(48.1%比24.7%,P<0.05)病人比例更高。其中非ST段抬高型心肌梗死病人比例较典型胸痛组高(46.2%比20.7%,P<0.05)。不典型症状心肌梗死病人组院前延误时间较长[(380±46)min比(240±21)min,P<0.05],在到达医院后确诊时间延长[(125±23)min比(20±5)min,P<0.05],接受急诊再灌注治疗者比率低(38.5%比70.6%,P<0.05)。不典型症状心肌梗死病人住院期间B型钠尿肽水平更高[(501±102)pg/mL比(305±83)pg/mL,P<0.05],心超测得射血分数较低[(43.6±7.2)%比(48.2±6.8)%,P<0.05],发生心力衰竭(30.8%比15.3%,P<0.05)及心源性休克(9.6%比5.3%,P<0.05)比例高。同时住院期间死亡率(15.4%比6.7%,P<0.05)较典型胸痛组高。结论不典型症状急性心肌梗死病人较典型胸痛心肌梗死病人年龄大,并发症多,就诊延迟,预后较差。

Objective To observe the clinical features,treatment and prognosis of acute myocardial infarction patients with typical or atypical chest pain.Methods 202 patients with acute myocardial infarction admitted to The Ninth People’s Hospital Affiliated to Shanghai Jiaotong University School of Medicine from June 2016 to May 2018 were enrolled,including 52 patients with atypical chest pain and 150 patients with typical chest pain.The clinical data were compared between those two groups.Results Compared with the typical myocardial infarction group with typical chest pain,the average age of onset of atypical symptoms in the acute myocardial infarction group was larger[(75.6±13.2)vs.(65.2±12.1),P<0.05],and there were more women(28.8%vs.18.7%,P<0.05)with diabetes(48.1%vs.24.7%,P<0.05).Among them,non⁃ST⁃segment elevation myocardial infarction is more(46.2%vs.20.7%,P<0.05).Patients with atypical symptoms of myocardial infarction had a longer pre⁃hospital delay[(380±46)min vs.(240±21)min,P<0.05],and the time to diagnosis was longer after arriving at the hospital[(125±23)min vs.(20±5)min,P<0.05].The rate of emergency reperfusion therapy was low(38.5%vs.70.6%,P<0.05).During hospitalization,brain natriuretic peptide levels were higher[(501±102)pg/mL vs.(305±83)pg/mL,P<0.05]and the ejection fraction was lower[(43.6±7.2)%vs.(48.2±6.8)%,P<0.05].The proportion of heart failure(30.8%vs.15.3%,P<0.05)and cardiac shock(9.6%vs.5.3%,P<0.05)was higher.Then the mortality rate(15.4%vs.6.7%,P<0.05)was higher than that of the typical chest pain group.Conclusion Patients with atypical acute myocardial infarction usually have characteristics of poor prognosis,elder age,more complications,delayed treatment.