临床实践中胸痛的病例分析

1、9月10日23时9月11日4时PCI术后当天PCI术后第二天 考虑非心血管疾病 ？按缺血性胸痛处理？Takakuwa KM, Halpern EJ. Radiology. 2008 Aug;248(2):438-46 White CS, Kuo D, Kelemen M, AJR Am J Roentgenol. 2005 Aug;185(2):533-40 Rusnak RA, Stair TO, Hansen K, et al. Litigation against the emergency physician: common features in cases of missed my

2、ocardial infarction.Ann Emerg Med. 1989, 18(10):1029-34.Rusnak RA, Stair TO, Hansen K, et al. Litigation against the emergency physician: common features in cases of missed myocardial infarction.Ann Emerg Med. 1989, 18(10):1029-34.Rusnak RA, Stair TO, Hansen K, et al. Litigation against the emergenc

3、y physician: common features in cases of missed myocardial infarction.Ann Emerg Med. 1989, 18(10):1029-34.8080年代国外研究表明：年代国外研究表明：在急诊室，在急诊室，AMIAMI被漏诊者同对照组比较，漏诊组病人多具有被漏诊者同对照组比较，漏诊组病人多具有以下特点：以下特点： 年龄低、胸痛症状不典型、心电图表现不典型。年龄低、胸痛症状不典型、心电图表现不典型。漏诊组的诊治医师也倾向于：漏诊组的诊治医师也倾向于： 病史采集不详尽、心电图识别错误、急症处理经验欠病史采集不详尽、心电图识别错误

4、、急症处理经验欠缺、住院病人管理病例数少。缺、住院病人管理病例数少。Sharon A. Stephen, Blair G et al. Symptoms of acute coronary syndrome in women with diabetes: an integrative review of the literature. Heart Lung. 2008 May-Jun;37(3):179-89 Sharon A. Stephen, Blair G et al. Symptoms of acute coronary syndrome in women with diabetes:

5、 an integrative review of the literature. Heart Lung. 2008 May-Jun;37(3):179-89 女性糖尿病病人合并女性糖尿病病人合并ACSACS是漏诊是漏诊ACSACS的高危人群。的高危人群。这类病人多表现为不典型胸痛这类病人多表现为不典型胸痛: : 疼痛部位多表现为背部、上肢、颈部、下颌等，或者表疼痛部位多表现为背部、上肢、颈部、下颌等，或者表现为轻微疼痛现为轻微疼痛(OR 0.71 and 95% CI 0.52 to 0.97)和无痛和无痛( (OR 1.31 and 95% CI 1.11 to 1.66) 。 同非糖尿病

6、病人比较，经校正年龄、性别、心肌酶水平、同非糖尿病病人比较，经校正年龄、性别、心肌酶水平、吸烟、高血压、高脂血症等基线资料后，气短是女性糖尿吸烟、高血压、高脂血症等基线资料后，气短是女性糖尿病病人出现病病人出现ACSACS的主要症状。的主要症状。Colman PG, Harper RW, et al. Transient anterior electrocardiographic changes simulating acute anterior myocardial infarction in diabetic ketoacidosis.Diabetes Care. 1982 Mar-Apr

7、;5(2):118-21.Colman PG, Harper RW, et al. Transient anterior electrocardiographic changes simulating acute anterior myocardial infarction in diabetic ketoacidosis.Diabetes Care. 1982 Mar-Apr;5(2):118-21.Hrtel D, Sorges E, Carlsson J, et al. Myocardial infarction and thromboembolism during pregnancy.

8、 Herz. 2003 May;28(3):175-84. Kimmoun A, Abboud G, Steinbach G, et al. Dissecting intramural hematoma of the esophagus: a rare cause of chest pain Presse Med. 2008 Mar;37(3 Pt 1):420-3Manzo V, Sun T, Lien YY. Misdiagnosis of acute myocardial infarction. Ann Clin Lab Sci. 1990 Sep-Oct;20(5):324-8 Manzo V, Sun T, Lien