蔡瑀

[摘要] 目的 探讨分析急性胸痛患者的发病原因及急诊救治方法与效果。方法 整群选取2017年1月—2018年1月该院急诊科收治的急性胸痛患者716例作为研究对象，回顾性分析相关临床资料，归纳总结患者的发病原因及诊治体会。结果 急性胸痛患者的发病原因主要包括心源性胸痛，其中急性ST段抬高型心肌梗死（STEMI）231例，不稳定型心绞痛（UA）371例，肺栓塞3例，夹层动脉瘤9例。非心源性胸痛患者102例，其中自发性气胸11.76%；肋间软骨炎9.80%，支气管肺炎占26.47%，消化道疾病占23.53%，胆道疾病占20.59%，肺癌、膈下脓肿、胸膜炎和带状疮疹各占7.84%。经过治疗治愈315例，好转351例，无效41例，死亡9例，治疗总有效率为93.02%。结论 急性胸痛的发病原因较为复杂，临床急诊应当根据患者的具体症状确诊病因，采取有针对性的急救措施进行治疗，以迅速缓解患者的危重症状，最大限度降低死亡率。

[关键词] 急性胸痛；发病原因；急诊治疗；诊治体会

[中图分类号] R5 [文献标识码] A [文章编号] 1674-0742（2018）04（c）-0050-03

Analysis of Causes and Diagnosis and Treatment of Patients with Emergency Acute Chest Pains

CAI Yu

Department of Emergency， Yulin First Peoples Hospital， Yulin， Guangxi， 537000 China

[Abstract] Objective To study and analyze the causes and diagnosis and treatment of patients with emergency acute chest pains. Methods 716 cases of acute chest pains admitted and treated in our hospital from January 2017 to January 2018 were selected， and the related clinical data were reviewed， and the causes and diagnosis and treatment experience of patients were summarized. Results The major causes of patients with acute chest pains included the cardiogenic chest pain， including 231 cases with STEMI， 371 cases with UA， 3 cases with pulmonary embolism and 9 cases with dissecting aneurysm， and 102 cases with non- cardiogenic chest pain， spontaneous pneumothorax 11.76%； intercostal chondritis 9.80%， bronchopneumonia 26.47%， digestive tract disease 23.53%， biliary tract disease 20.59%， lung cancer 7.84%， phrenic abscess 7.84%， pleurisy and zonal eruption 7.84%， after treatment， 315 cases were cured，351 cases were improved， 41 cases were ineffective and 9 cases died， and the total treatment effective rate was 93.02%. Conclusion The causes of acute chest pains are complex， and we should confirm the causes according to the specific symptoms of patients， and take the targeted emergency measures to rapidly relieve the critical symptoms and reduce the morbidity to a largest extent.

[Key words] Acute chest pain； Cause； Emergency treatment； Diagnosis and treatment experience

急性胸痛是一種以胸部疼痛为主要临床症状的急诊常见病症，具有发病突然、病情进展迅速、病因复杂等特点[1]。由于引起急性胸痛的疾病种类很多，包括心肌炎、心肌梗死、心绞痛、胸部疖痈、肺炎、支气管炎等，病情控制难度较大，如果治疗方法不当或者治疗不及时，可对患者的生命安全构成严重威胁[2-3]因而治疗的关键在于明确判断发病诱因，采取有针对性的治疗措施[4]。该次研究整群选取2017年1月—2018年1月收治的急性胸痛患者716例作为对象，着重探讨分析急性胸痛患者的发病原因及进行诊断治疗的方法，现报道如下。……