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目的探讨急性心肌梗死临床误诊原因及预防措施。方法对自2005年1月至2008年1月38例误诊病例进行回顾分析。结果误诊为心力衰竭2例,心律失常5例,休克2例,急性胃肠炎5例,消化性溃疡13例,胆囊炎2例,上消化道出血2例,脑梗死3例,牙痛2例,下颌痛2例。结论对老年患者,糖尿病患者,有并发症的患者突然发生的严重心律失常、休克、新出现或者原有的心力衰竭加重而原因未明的,或突然发生较重而持久的胸闷、喘憋、晕厥、极度的衰弱无力、急性消化不良、咽痛、牙痛、肩痛等常规难以解释的症状时要考虑到急性心肌梗死。患者就诊时内科医师一定要详细询问病史、详细体格检查,对诊断不明的患者,应常规予心电图检查,对于可疑病例,应动态观察心电图、肌酸激酶同工酶(CK-MB)、肌钙蛋白(cTnT),以减少急性心肌梗死误诊漏诊。
Objective To investigate the causes and preventive measures of clinical misdiagnosis in acute myocardial infarction. Methods From January 2005 to January 2008, 38 cases of misdiagnosis were retrospectively analyzed. Results Misdiagnosed as heart failure in 2 cases, arrhythmia in 5 cases, shock in 2 cases, acute gastroenteritis in 5 cases, peptic ulcer in 13 cases, cholecystitis in 2 cases, upper gastrointestinal bleeding in 2 cases, 3 cases of cerebral infarction, 2 cases of toothache , Jaw pain in 2 cases. Conclusion For elderly patients, patients with diabetes, patients with complications of sudden severe arrhythmia, shock, new or existing heart failure increased due to unexplained or sudden and severe chest tightness, wheezing, syncope , Extreme weakness, acute dyspepsia, sore throat, toothache, shoulder pain and other conventional difficult to explain the symptoms to be considered when acute myocardial infarction. Physicians should consult the patient’s medical history in detail, detailed physical examination, diagnosis of unknown patients should be routine to ECG, suspected cases of electrocardiogram should be dynamic observation, creatine kinase (CK-MB), muscle calcium Protein (cTnT) to Reduce Misdiagnosis of Acute Myocardial Infarction.