急性冠脉综合征误诊23例临床分析

目的探讨急性冠脉综合征（ACS）误诊的临床原因及预防措施。方法回顾性分析23例ACS患者的病例资料。结果23例人院时诊断为心力衰竭3例,急性胃肠炎4例,急性胰腺炎3例,肋间神经疼2例,腹腔积液原因待诊1例,急性咽炎1例,椎基底动脉供血不足1例,脑梗死2例,高血压性心脏病2例,频发室性早搏3例,急性胆囊炎、胆石症1例。结论ACS临床表现具有复杂性、多样性,详细的病史采集、心电图的动态观察和心肌损伤标记物检测是降低误诊率的关键。     

急性冠脉综合征二例误诊分析

1　病例资料【例 1】　男 ,60岁。高血压病史 5年 ,间断服尼群地平 ,血压维持在 14 0～ 166/90～ 10 0mmHg。因左下颌痛 10天 ,加剧 5小时急诊入院。入院前 10天开始出现左下颌痛伴咀嚼困难 ,约 15分钟后自行缓解 ,每天发作 1～ 3次 ,到当地医院诊为左下第 2磨牙牙龈炎 ,予甲硝唑等口服 ,嘱戒嚼槟榔 ,未见明显疗效 ,仍反复发作左下颌痛 ,且活动、激动时加剧 ,休息可缓解。 2 0 0 1年 10月 15日又到当地医院复诊 ,拔除左下第 2磨牙 ,效果不佳。入院前 5小时活动后左下颌剧痛 ,伴胸闷 ,大汗急诊入院。查体 :血压15 0 /90mmHg。双肺无音 ,心…     

60例胸痛患者误诊为急性冠脉综合征分析

目的分析60例胸痛患者误诊为急性冠脉综合征的误诊原因,探讨避免误诊的方法。方法选取2010年1月至2013年12月博爱县人民医院误诊为急性冠脉综合征的胸痛患者60例,综合分析其误诊原因并进行分析。结果本院胸痛患者误诊为急性冠脉综合征的综合误诊率为3.79%,误诊的60例患者出现胸痛的真正病因分别为:消化系统疾病26例,呼吸系统疾病18例,主动脉夹层及主动脉夹层动脉瘤8例,带状疱疹4例,其他4例。结论应尽力避免将胸痛患者误诊为急性冠脉综合征,以免延误病情,增加患者痛苦。     

急性腹痛21例误诊分析

腹痛可由腹部或腹外器官疾病所引起，由于原因复杂、诊断常需详细的病史与全面的检查．有时还须借助剖腹探查才能确诊，稍有疏忽将造成误诊。本收集我院1993年3月到2997年3月以腹痛急诊就医收入内科诊治，后经全面体格检查、辅助检查及转外科、妇科手术后证实误疹21例，现作一简要分析。     

妇科急腹症误诊为急性阑尾炎的原因及对策

目的：探讨分析妇科急腹症误诊为急性阑尾炎的原因及防治对策。方法：对经手术证实的27例误诊病例分析误诊原因。结果：18例妇科相关史不完整，4例无妇科相关史记录，无1例行妇科相关检查。。结论：忽视对妇科相关史的采集和分析，缺少必要的妇科检查，思维的局限是造成误诊的主要原因。     

20例急性阑尾炎的误诊原因分析

对我院诊断为急性阑尾炎,后经手术治疗证实为其他疾病的患者20例的临床资料进行分析,探讨急性阑尾炎误诊的原因。结果 20例患者中4例为胃溃疡穿孔,6例为十二指肠球部溃疡穿孔,均给予溃疡穿孔修补术治疗;5例为回肠坏死性憩室炎,术中快速病理证实为结肠癌,均给予结肠癌根治术治疗;2例为盲肠炎性肉芽肿,均给予引流和抗炎治疗;2例为睾丸扭转,术中发现睾丸已经坏死,给予切除治疗;1例患者为黄体破裂,给予卵巢修补术治疗。不仔细询问病史、不全面的体格检查、不完善的辅助检查是误诊为急性阑尾炎的主要原因,认真询问病史、系统的体格检查、综合分析辅助检查结果是减少急性阑尾炎误诊的关键。     

急性冠脉综合症患者死亡率与内皮细胞激活因子的相关性研究

目的：探讨急性冠脉综合症（ACS）患者死亡率与内皮细胞激活因子的相关性。方法：检测未接受冠状动脉介入治疗的339例ACS患者血浆中的血浆血管性血友病因子（VwF）、血浆血管性血友病因子前肽（VwF：pp）和骨保护素（OPG）,观察其与住院期间死亡的关系。结果：住院期间死亡（死亡组）46例,存活（存活组）293例。死亡组VwF：pp明显高于生存患者组（P〈0．05）;高浓度OPG者的死亡率明显高于低浓度OPG者（P〈0．05）。结论：未接受冠状动脉介入治疗的ACS患者中,内皮细胞功能的激活和紊乱与住院期间死亡率相关。     

急性冠脉综合征误诊为慢性胃炎

【病例】男，70岁。因发作性上腹部疼痛7天，加重1天入院。患者于7天前在饱餐后出现上腹部疼痛，无恶心、呕吐，无腹胀、腹泻。无胸闷、胸痛等。在某省级医院消化内科诊断为慢性胃炎。予雷尼替丁、健胃消食片等药物治疗。症状时好时坏。近1天来上腹部疼痛发作频繁，持续时间较前延长，在入院当天清早步行活动10分钟后出现上腹痛加重，伴胸前区闷痛、心慌、气短。查体：体温36．5℃．     

老年急性冠脉综合症高敏C反应蛋白变化的临床意义研究

目的 :探讨高敏C反应蛋白 (hs-CRP)在老年急性冠脉综合症中的意义及与疾病的关系 ,为老年冠心病预测后提供简便易行的检测及观察方法。方法 :老年冠心病 15 7例 ,根据冠心病病情分为稳定性心绞痛组(SAP) ,不稳定性心绞痛组 (UAP) ,心肌梗死组 (AMI) ,另设对照组。结果 :对照组、SAP、UAP、AMI各组间血清hs-CRP浓度比较均有显著差异 (P <0 0 0 1)结论 :hs-CRP浓度可判断冠心病严重程度 ,血清hs -CRP浓度与发生急性冠脉综合症密切相关 ,并可作为冠心病患者判断预后的指标。     

急性冠脉综合征患者的护理

笔对34例急性冠脉综合征患进行分析，提出护理要点：按心肌梗死常规护理，加强相关指标的监测。尽早明确诊断；预防并发症，重视不典型表现，注意体温的变化，加强监护；积极做好原发病的防治及护理；加强心理护理及康复指导。     

Fibrinolysis in patients with acute coronary syndrome

The reperfusion therapy including both fibrinolytic therapy and primary percutaneous coronary intervention (PCI) has been established in patients with ST-segment elevation acute myocardial infarction (STEMI). Fibrinolysis has the advantage of universal availability and short time to administration. Because the benefit of fibrinolysis is directly related to the time from symptom onset to treatment as demonstrated in many studies, every effort must be made to minimize any delays between symptom onset and the initiation of a safe and effective reperfusion strategy in patients with STEMI. Although the benefit of fibrinolysis is limited by inadequate reperfusion or reocclusion of the infarct-related artery in a sizable portion of patients, fibrinolysis followed by planned PCI can be one of approaches in patients presenting within 2 or 3 hours from onset of STEMI.     

急性冠脉综合征370例护理体会

对370例急性冠脉综合征患者进行分析，提出护理要点：尽早明确诊断；加强相关指标的监测；预防并发症；加强心理护理及康复指导；积极做好原发病的防治及护理。     

Statin treatment in patients with acute coronary syndrome

In PROVE IT trial, intensive lipid-lowering therapy with statin (80 mg of atorvastatin daily) provides greater protection against cardiovascular events than does a standard regimen (40 mg of pravastatin daily) in patients with acute coronary syndrome (ACS), indicating that such patients benefit from early and continued lowering of LDL cholesterol to levels substantially below current target levels. However, differences between Japanese and Westerns as far as atherogenesis and response to statins are concerned, remain an unsolved problem that requires additional investigation. New guideline for the management of patients with ACS is needed for Japanese patients.     

PCI for the patients with acute coronary syndrome

Numerous clinical trials have been conducted to compare therapeutic efficacy of thrombolysis and that of primary percutaneous coronary intervention (PCI) in the patients with acute coronary syndrome (ACS). Several recent meta-analyses revealed that primary PCI provides better short-term and long-term clinical results for ACS patients than thrombolysis does. However, in order to obtain such benefit of primary-PCI, PCI procedure has to be done by the team of well-trained angioplasters and para-medical staffs with on-site surgical back-up, as indicated by the JCS guideline for ACS treatment.     

Electrocardiographic diagnosis in patients with acute coronary syndrome

Electrocardiographic role in a diagnosis of ischemic heart disease has still important value. As important electrocardiographic findings of myocardial ischemia, there are ST elevation or depression, increase high T wave (hyperacute T wave), negative T wave and negative U wave, but it is particularly important to compare those findings and manifestation. Because the patient can always carry it, event ECG is advantageous in that they can record electrocardiography by themselves when they have some symptom. It is necessary to have attention to what abnormal findings of the electrocardiogram which it is easy to be overlooked such as increase T wave or negative U wave appear in early stage of phase of acute coronary syndrome. When the patient has some symptom that acute coronary syndrome is thought about, it is necessary to record electrocardiograms on several times and to do follow up even if there is no electorcardiographic abnormalities at first recording.     

Managing patients with non-ST-segment elevation acute coronary syndrome

Acute coronary syndromes (ACSs) can be described as ST-segment elevation or non-ST-segment elevation, including unstable angina. Traditionally, ST-segment elevation ACS has been considered to be more serious, but non-ST-segment elevation ACS has higher mortality rates in the longer term. This article discusses diagnosis, including history taking, clinical examination, electrocardiogram and biochemical markers that help to differentiate between types of non-ST-segment elevation ACSs. Risk stratification and treatment strategies are examined, as well as pharmacological treatments. The nurse's role in assessment, treatment, ongoing management and discharge practice is discussed.     

Carbohydrate exchange in patients with acute coronary syndrome

Blood sugar measurement may be important for determining therapeutic tactics in patients in urgent pathological conditions. The role of hyperglycemia in the development of acute myocardial ischemia is under constant study, because the risk of death from myocardial infarction (MI) in patients with diabetes mellitus (DM) is twice higher than in those who do not suffer from DM. Having studied literature data, presented in the article, the authors report preliminary results of their work. Carbohydrate exchange disturbances are found almost in a half (49.1%) of patients with acute coronary syndrome (ACS). In patients with substantial and severe ACS manifestations that were considered to be those of acute myocardial infarction (MI) with ST interval elevation, as well as in patients with a repeated MI, carbohydrate exchange disorder was revealed in 65% and 77% of cases. In 30% of patients with a repeated MI, and in 14% of patients with MI with ST interval elevation, hyperglycemia was transient and disappeared on its own. Evaluation of this group of patients revealed type 2 DM in 44% of cases, which once more confirmed the information that DM patients were more liable to atherothrombosis. In half of the patients DM was newly revealed. This can be explained by the fact that a stressful situation urged revealing of the disease, which otherwise could be concealed. Data that suggest a higher hyperglycemia level in patients who finally could not be saved are of certain importance.     

Impact of gender in patients with acute coronary syndrome

In this article, we review the impact of gender on the pathophysiology, management and outcomes after acute coronary syndrome (ACS). We searched the English-language literature indexed in MEDLINE, Scopus and EBSCOhost Research databases from 1988 through January 2009 using the indexing terms ‘gender’, ‘short- and long-term outcomes’ and ‘acute coronary syndrome’ and ‘myocardial infarction’. Data comparing gender differences in outcomes after ACS showed that females have a higher mortality rate than males. Observational studies showed that guideline-recommended management strategies are used significantly less frequently in females than males. The undertreatment and worse outcome of female patients with ACS are probably multifactorial and have been reported in different ethnicities and cultures. However, there are conflicting data regarding to the impact of gender on early versus long-term outcomes, the benefit of early intervention in low- and high-risk females and the influence of unmeasured selection biases in the use of therapies in the observational data. These gender discrepancy trends warrant close follow-up, as this might reflect changes in primary and secondary prevention in the community. Furthermore, gender discrepancy gives an indication of healthcare quality and whether care is given in an unbiased manner. All high-risk females, and males with ACS, should receive optimal medical management, coronary angiography and revascularization whenever indicated.