813例急性胸痛患者的临床分析

摘要

Objective To analyze patients with acute chest pain as their chief complaint in order to improve our capability of early identifying and diagnosing high-risk patients,give them proper treatment in time and avoid misdiagnosis and improper treatment. Methods The clinical data of 813 patients with chest pain as their chief complaint admitted in the emergency department and critical care medicine department in Guangdong Provincial Traditional Chinese Medicine Hospital from January to December in 2011 were retrospectively analyzed. According to the process of diagnosis and treatment formulated by the chest pain center,all the patients must immediately finish the first electrocardiograph(EEC)examination in 10 minutes and the relevant blood biochemical examinations within 30 minutes after admission. Results In accordance with the relevant examinations,the confirmed diagnoses were as follows:there were 276 cases of unstable angina,accounting for 33.95%;145 cases of stable angina,17.84%;121 cases of acute myocardial infarction,14.88%;103 cases of respiratory system disease,12.67%;78 cases of skeletal muscle disease,9.59%;46 cases of the digestive system disease,5.66% and the high-risk non cardiac chest pain(such as aortic dissection/rupture of tumor or acute pulmonary embolism)12 cases,1.48%.Seven hundred and eighty-five patients finished the first EEC examination in 10 minutes,and 147 patients completed the chest computed tomography(CT)scan within an hour. Conclusions Acute chest pain is a common symptom in emergency department. It is necessary to identify the high-risk patients according to a process as soon as possible in order to get an accurate diagnosis and an effective treatment in time.%目的：分析总结2011年广东省中医院急诊科和重症医学科以急性胸痛为主要症状就诊患者的诊治情况，以期提高对急诊科高危胸痛患者的早期识别、诊断并及时给予对症处理，避免漏诊误诊。方法对本院2011年1月至12月收治的813例急性胸痛患者的临床诊疗情况进行回顾性分析。所有胸痛就诊患者均按胸痛中心制定的胸痛诊治流程实施，即在10 min内完成第1份心电图检查，30 min内完成相关性生化项目的采集检查。结果根据相关检查最后确诊，各疾病所占比例由高到低依次为不稳定型心绞痛276例，占33.95%；稳定型心绞痛145例，占17.84%；急性心肌梗死121例，占14.88%；呼吸系统疾病103例，占12.67%；骨骼肌肉疾病78例，占9.59%；消化系统46例，占5.66%；高危非心源性胸痛（主动脉夹层/瘤撕裂、急性肺栓塞）12例，占1.48%。785例患者在10 min内完成第1份心电图检查，147例在1 h内完成胸部CT平扫。结论急性胸痛是急诊科常见症状，需要按流程快速识别出高危胸痛患者，并给予及时、有效处理。