摘要
目的探索老年人急性心肌梗死（ＡＭＩ）易漏诊的原因，以提高对老年人心肌梗死的正确诊断率。方法总结２０年中尸检有ＡＭＩ老年患者的临床与病理资料。结果４６例ＡＭＩ中１１例（２３．９％）发生在危重疾病的终末期，其中９例漏诊，占４６例的１９．６％，占１１例的８１．８％。１１例临床上均患冠心病及其它疾病，尸检均有冠状动脉粥样硬化病变１～３支，管腔狭窄Ⅲ～Ⅳ级。心肌梗死部位：左室前壁或前侧壁６例，心内膜下２例，左室乳头肌、室间隔、心尖部和右室各１例。４例心脏破裂。结论ＡＭＩ的症状易被肿瘤晚期症状和脑血管病的意识障碍等所掩盖，临床上应尽可能多次检查心电图及心肌酶谱，以降低ＡＭＩ漏诊率。
Objective To find the causes of misdiagnosis of acute mycardial infarction (AMI) in aged patients with other critical diseases, so as to increase the rate of accurate diagnosis. Methods The data of 46 aged AMI cases with autopsy performed in a period of 20 years were analysed. Results Eleven(239%) of the 46 cases were found to have critical diseases other than AMI. The diagnosis of AMI was missed in 9 of the 11 cases; the rate of misdiagnosis was 818%. Clinically all the 11 patients had coronary heart disease and some critical terminal diseases such as malignancy, cerebrovascular diseases, hypertension or diabetes. Pathologically coronary atherosclerosis with grade 34 stenosis involving 13 vessels was found in all the 11 patients. Four patients had cardiac rupture. The presence of malignancy or cerebrovascular diseases were confirmly pathologically. Conclusions The clinical manifestation of AMI in aged patients with other critical diseases may be concealed by the symptoms of advanced malignancy or not be known due to the impaired mentality in patients with cerebrovascular diseases, so the rate of misdiagnosis of AMI in such patients is quite high. Clinicians should be on guard against the possible presence of AMI in aged patients with other critical diseases and monitor the patients with frequent ECG examination and estimation of myocardial enzymes.
出处
《中华老年医学杂志》
CAS
CSCD
北大核心
1997年第6期356-357,共2页
Chinese Journal of Geriatrics
