不典型急性心肌梗死22例临床分析

目的:分析急性心肌梗死临床诊疗过程,做到早期发现、早期治疗,以降低心肌梗死患者住院死亡率.方法:收集2000～2009年临床表现、心电图、心肌酶学不典型急性心肌梗死患者22例进行回顾分析.结果:22例患者中以呼吸系统症状为首发表现4例,脑血管系统表现、心力衰竭表现各5例,以消化道系统表现3例,疼痛部位异常(牙痛、头痛各2例、肩痛1例).平均入院到确诊心梗时间为12小时,其中死亡1例,转入上级医院2例,经相应治疗好转出院19例.结论:不能忽视急性心肌梗死心外表现,要重视心电图、心肌酶学的动态观察、心肌坏死的血清心肌标记物浓度动态改变的重要作用,全面分析做出正确的诊断.

Retrospective analysis of 22 cases with atypical myocardial infarction

Objective：To perform retrospective analysis of clinical diagnosis and treatment of acute myocardial infarction for improv-ing rate of early diagnosis of this disease and ensuring early identification and treatment,consequently,reducing hospital mortality.Meth-ods：A total of 22 patients hospitalized from 2000 to 2009,whose clinical manifestations,electrocardiogram and myocardial enzymes did not meet the typical diagnostic criteria of acute myocardial infarction,were analyzed retrospectively.Results：Respiratory symptoms were the initial symptoms in 4 of 22 patients and cerebral vascular system performance was found in 5 cases,hear failure in 5 cases,gastroin-testinal manifestations in 3 cases.Some patients showed distant site pain,including toothache and headache in each 2 cases and shoulder pain in 1 case.The average time of admission to the diagnosis of myocardial infarction was 12 h.One of 22 cases died,2 patients were transferred to higher level hospitals,and 19 cases were relieved and discharged after appropriate treatment.Conclusion：Atypical perfor-mance of acute myocardial infarction should be paid great attention,particularly,dynamic observation of electrocardiogram,myocardial en-zymes markers for myocardial necrosis,so as to comprehensively analyse the pathogenetic condition and make the correct clinical diagnosis.