首诊时心电图正常的不稳定型心绞痛预后与诊治的关系

目的探讨首诊心电图(ECG)正常时不稳定型心绞痛预后与诊治的关系。方法对173例不稳定型心绞痛患者按就诊时检测的心电图结果分为ECG正常组(52例)和ECG缺血组(121例),将两组诊断、治疗情况及预后进行比较分析。同时根据首诊诊疗情况将ECG正常组分为误诊组(A组,17例)、治疗失当组(B组,16例)及诊疗合理组(C组,19例),比较分析A、B、C三组心绞痛危险分层、预后影响因素及预后。结果ECG正常组首诊误诊17例(占33%),其中5例发生心肌梗死;治疗失当16例(占46%),其中5例发生心肌梗死。ECG缺血组首诊即得到正确诊断及治疗,有3例发生心肌梗死。两组分项比较差异有统计学意义(P<0.05)。A、B、C三组心绞痛危险分层、预后影响因素比较差异无统计学意义(P>0.05)。与C组比较心肌梗死发生,A、B组差异均有统计学意义(P<0.05)。结论首诊时心电图表现正常的不稳定型心绞痛不良预后原因主要为误诊及治疗失当。

Relationship between prognosis and diagnosis and treatment of unstable angina with normal ECG during first visit

Objective To study the relationship between prognosis and diagnosis and treatment of unstable angina (UA) with normal ECG during the first visit. Methods One hundred and seventy-three cases with UA were divided into normal ECG group (n=52) and ischemia ECG group (n=121) according to ECG performed in diagnosis.The patients in both groups were observed for comparison of diagnosis and treatment and treatment and prognosis.Cases with UA and normal ECG group were divided into misdiagnosed group (Group A,n=17),unreasonably-treated group (Group B,n=16) and correctly-treated group (Group C,n=19) according to diagnosis and treatment during the first visit.The patients in three groups were observed for comparison of the risk classification of UA,the prognostic factors of UA and prognosis.Results In normal ECG group,during the first visit,17 cases (33%) were diagnosed incorrectly, 5 cases developed into myocardial infarction, 16 cases (46%) were treated unreasonably and 5 cases developed into myocardial infarction.In ischemia ECG group,all cases were diagnosed correctly and treated reasonably,and 3 cases developed into myocardial infarction.There were significant difference in the above index between normal and ischemia ECG group.There were no significant difference in such indexes as the risk classification of UA and prognostic factors of UA among Group A,B and C.The cases developed into myocardial infarction in Group A and B are much more than those in Group C (P<0.05).Conclusion Misdiagnosis and unreasonable treatment are the causes of poor prognosis caused by UA with normal ECG during the first visit.