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目的:了解急性心肌梗死(AMI)的非典型临床表现,以期提高早期诊断,减少漏、误诊率及降低死亡率。方法:对256例AMI患者进行回顾性总结分析。结果:非典型AMI患者共72例(28.1%);与典型AMI患者相比,非典型患者年龄高(69.8岁︰58.5岁,P<0.01),女性比例高(43.1%︰30.4%,P<0.01),伴发糖尿病(33.3%︰23.9%,P<0.01)和心力衰竭(20.8%︰13.6%,P<0.01)比例高,住院期间死亡率高(33.3%︰5.2%,P<0.01),平均就诊时间显著延迟(24.5h︰9.8h,P<0.01),入院时确诊率显著降低(20.6%︰53.4%,P<0.01)。结论:AMI的非典型临床表现相当普遍,导致较高的漏、误诊率,且住院期间病死率显著增加,早期识别能有效提高确诊率,对改善预后有极其重要的意义。
Objective: To understand the atypical clinical manifestations of acute myocardial infarction (AMI) in order to improve early diagnosis, reduce leakage, misdiagnosis rate and reduce mortality. Methods: 256 patients with AMI were retrospectively analyzed. Results: Atypical AMI patients were 72 (28.1%). Compared with the typical AMI patients, the atypical patients were higher age (69.8 years: 58.5 years, P <0.01) and women were higher (43.1%: 30.4%, P < 0.01), high incidence of concomitant diabetes (33.3%: 23.9%, P <0.01) and heart failure (20.8%: 13.6%, P <0.01) The mean time to visit was significantly delayed (24.5h: 9.8h, P <0.01). The diagnosis rate at admission was significantly lower (20.6%: 53.4%, P <0.01). Conclusions: The atypical clinical manifestations of AMI are quite common, leading to high leakage and misdiagnosis rates and significant increase of mortality during hospitalization. Early identification can effectively improve the diagnosis rate, which is extremely important for improving prognosis.