不典型急性心肌梗死院前诊治

目的提高不典型性急性心肌梗死的院前诊治水平，避免误诊误治。方法回顾性分析我院近5年对28例不典型性急性心肌梗死的院前诊治和院内诊治的临床资料，并文献复习。结果28例不典型急性心肌梗死患者中，主诉偏离循环系统症状占92．9％，以消化系统症状为主诉占50．0％，未行院前心电图检查8例，占28．6％，院前心电图复杂难辨呈不典型性20例，占71．4％，院前误诊率达92．9％。结论院前急救人员应认识急性心肌梗死患者的症状及心电图存在不典型性，重视心电图检查及提高辨认心电图的水平。

Diagnosis and treatment of atypical acute myocardiac infarction in prehospital emergency

Objective To improve diagnosis of atypical acute myocardiac infarction(AMI) in prehospital care. Methods The clinical data of 28 patients with AMI from 2000 to 2005 were analyzed retrospectively, and the related literature were reviewed. Results Of 28 patients, the main complaint of 26 patients (26/28, 92.9%) deviated from cardiovascular symptom, and 14 patients (14/28, 50%) with digestive symptom. Prehospital electrocardiogram examination did not performed in 8 patients (8/28, 28.6%), and electrocardiogram of 20 patients(20/28, 71.4%) were complicated and atypical. Twenty-six patients(26/28, 92.9%) in prehospital care were misdiagnosed. Conclusion The atypical characteristics of AMI should be well-regarded, and how to identify complicated electrocardiogram of AMI is very important.