临床实践中胸痛的病例分析精选课件.ppt

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.2019 Aug;248(2):438-46 White CS,Kuo D,Kelemen M,AJR Am J Roentgenol.2019 Aug;185(2):533-40 Rusnak RA,Stair TO,Hansen K,et al.Litigation against the emergency physician:common features in cases of missed myocardial infa

2、rction.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 emergency physician:common feature

3、s 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、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

4、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.2019 May-Jun;37(3):179-89 Sharon A.Stephen,Blair G et al.Symptoms of acute coronary syndrome in women with diabetes:an integrative review of the literature.

5、Heart Lung.2019 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、

6、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;5(2):118-21.Colman PG,Harper RW,et al.Transient anterio

7、r 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.Herz.2019 May;28(3):175-84.Kimmoun A,Abboud G,Steinbach G,et al.

8、Dissecting intramural hematoma of the esophagus:a rare cause of chest pain Presse Med.2019 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 YY.Misdiagnosis of acute myocardial infarction.Ann Clin Lab Sci.1990 Sep-Oct;20(5):324-8 再见再见 谢谢谢谢Thank youWangningfuhotmail