臨床實踐中胸痛的病例分析課件

1、9月10日23時9月11日4時PCI術后當天PCI術后第二天 考慮非心血管疾病 ？按缺血性胸痛處理？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年代國外研究表明：年代國外研究表明：在急診室，在急診室，AMIAMI被漏診者同對照組比較，漏診組病人多具有被漏診者同對照組比較，漏診組病人多具有以下特點：以下特點： 年齡低、胸痛癥狀不典型、心電圖表現(xiàn)不典型。年齡低、胸痛癥狀不典型、心電圖表現(xiàn)不典型。漏診組的診治醫(yī)師也傾向于：漏診組的診治醫(yī)師也傾向于： 病史采集不詳盡、心電圖識別錯誤、急癥處理經(jīng)驗欠病史采集不詳盡、心電圖識別錯誤

4、、急癥處理經(jīng)驗欠缺、住院病人管理病例數(shù)少。缺、住院病人管理病例數(shù)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是漏診是漏診ACSACS的高危人群。的高危人群。這類病人多表現(xiàn)為不典型胸痛這類病人多表現(xiàn)為不典型胸痛: : 疼痛部位多表現(xiàn)為背部、上肢、頸部、下頜等，或者表疼痛部位多表現(xiàn)為背部、上肢、頸部、下頜等，或者表現(xiàn)為輕微疼痛現(xiàn)為輕微疼痛(OR 0.71 and 95% CI 0.52 to 0.97)和無痛和無痛( (OR 1.31 and 95% CI 1.11 to 1.66) 。 同非糖尿病

6、病人比較，經(jīng)校正年齡、性別、心肌酶水平、同非糖尿病病人比較，經(jīng)校正年齡、性別、心肌酶水平、吸煙、高血壓、高脂血癥等基線資料后，氣短是女性糖尿吸煙、高血壓、高脂血癥等基線資料后，氣短是女性糖尿病病人出現(xiàn)病病人出現(xiàn)ACSACS的主要癥狀。的主要癥狀。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