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自1984年至1993年,我院有19例急性心肌梗塞(心便)误诊,误诊为急性左心衰6例、消化道疾病5例、呼吸道疾病3例、脑血管病和神经官能症各2例、牙病1例。举例分析如下。 例1:男,54岁。因上腹部剧痛伴恶心呕吐2小时来诊。查体:DP16/8kPa,表情痛苦,上腹无压痛,诊为急性胃炎,肌注阿托品1mg半小时后痛无缓解,面色苍自、大汗,测血压12/7kPa,急查心电图示急性下壁心便。 分析:因迷走神经传入纤维感受器几乎都位于心脏后下壁表面,当心肌缺血缺氧时刺激迷走神经,这是心脏后下壁梗塞产生腹痛的原因,临床常表现突发性腹痛伴恶心呕吐,易与急腹症混淆,但前者一般无上腹压痛,且多件有胸闷,可予鉴别。 例2:男,52岁。原有慢性支气管炎。4小时
From 1984 to 1993, 19 cases of acute myocardial infarction (stool) misdiagnosis in our hospital were misdiagnosed as acute left heart failure in 6 cases, gastrointestinal disease in 5 cases, respiratory disease in 3 cases, cerebrovascular disease and neurosis 2 Cases, dental disease in 1 case. Examples are as follows. Example 1: Male, 54 years old. Due to abdominal pain with nausea and vomiting 2 hours to diagnosis. Physical examination: DP16 / 8kPa, facial expression pain, abdominal tenderness, diagnosed with acute gastritis, intramuscular injection of atropine 1mg half an hour after the pain without remission, looking Cang, sweating, blood pressure 12 / 7kPa ECG emergency ECG Wall heart. Analysis: Vagal afferent fiber receptors are almost located in the heart wall after the lower wall, when the myocardial ischemia and hypoxia to stimulate the vagus nerve, which is the heart of the lower wall infarction abdominal pain, the clinical manifestations of sudden abdominal pain with nausea and vomiting, Easily confused with acute abdomen, but the former generally no upper abdominal tenderness, and multiple chest tightness, can be identified. Example 2: Male, 52 years old. The original chronic bronchitis. 4 hours