CAJ | 학술논문

目的：探讨急性冠状动脉综合征（acute coronary syndrome, ACS)急诊分层诊断的可行性,提高急诊医生对 ACS 的诊断水平。方法选择2013年3—8月因胸痛及胸痛等同症状在我院急诊科就诊且资料完整患者288例,通过急诊分层诊断流程及标准将患者分为 ACS 组（192例)和非 ACS 组（96例),观察两组一般情况、确诊结果及临床转归情况,并分析急诊分层诊断流程及标准对 ACS 诊断的敏感性及特异性。结果两组性别、症状出现时间差异有统计学意义（P <0．05),年龄差异无统计学意义（P >0．05)。 ACS 组经冠状动脉造影确诊为 ACS 173例,非 ACS组中确诊 ACS 3例,ACS 组初诊诊断符合率90．1%（173/192),非 ACS 组初诊诊断符合率96．9%（93/96)。急诊分层诊断流程及标准对 ACS 诊断的敏感性为98．3%,特异性为83．0%。 ACS 组住院期间死亡 2例,非 ACS 组随访30 d 无死亡病例。结论对因胸痛及胸痛等同症状就诊的急诊患者行 ACS 分层诊断,可初步实现 ACS 的早期诊断及规范化治疗,降低漏诊率,避免过度医疗。
목적：탐토급성관상동맥종합정（acute coronary syndrome, ACS)급진분층진단적가행성,제고급진의생대 ACS 적진단수평。방법선택2013년3—8월인흉통급흉통등동증상재아원급진과취진차자료완정환자288례,통과급진분층진단류정급표준장환자분위 ACS 조（192례)화비 ACS 조（96례),관찰량조일반정황、학진결과급림상전귀정황,병분석급진분층진단류정급표준대 ACS 진단적민감성급특이성。결과량조성별、증상출현시간차이유통계학의의（P <0．05),년령차이무통계학의의（P >0．05)。 ACS 조경관상동맥조영학진위 ACS 173례,비 ACS조중학진 ACS 3례,ACS 조초진진단부합솔90．1%（173/192),비 ACS 조초진진단부합솔96．9%（93/96)。급진분층진단류정급표준대 ACS 진단적민감성위98．3%,특이성위83．0%。 ACS 조주원기간사망 2례,비 ACS 조수방30 d 무사망병례。결론대인흉통급흉통등동증상취진적급진환자행 ACS 분층진단,가초보실현 ACS 적조기진단급규범화치료,강저루진솔,피면과도의료。
Objective To explore the feasibility of hierarchical diagnosis for patients with acute coronary syndrome (ACS) in order to improve the diagnostic ability of ACS in emergency department (ED). Methods A total of 288 patients with chest pain or equivalent symptom from March to August 2013 were divided into ACS group (n = 192) and non-ACS group (n = 96) according to hierarchical diagnostic flowsheet. The general conditions, definite diagnostic outcomes and clinical turn-over by following up in the two groups were observed, and sensitivity and specificity of diagnostic flowsheet and standard using hierarchical diagnosis were analyzed. Results The differences in gender and symptom occurrence time in the two groups were statistically significant (P < 0. 05), but the difference in ages was not statistically significant (P > 0. 05). A total of 173 pa-tients were confirmed with having the ACS by coronary arteriongraphy in ACS group, and 3 patients were confirmed with having the ACS in non-ACS group. The accordance rate of preliminary diagnosis in ACS group was 90. 1% (173 / 192), while the rate in non-ACS group was 96. 9% (93 / 96). The sensitivity was 98. 3% , and specificity was 83. 0% . Two patients died in hospital in ACS group, but no one died in non-ACS group with follow-up for 30 d. Conclusion ACS hierarchical diagnosis in patients with chest pain or equivalent symptom can achieve preliminary ACS early diagnosis and standardized treatment in order to reduce misdiagnosis rate and avoid excessive therapy.