胃食管反流病误诊为冠心病26例原因分析.docVIP

精品论文 参考文献 胃食管反流病误诊为冠心病26例原因分析 鲁增寿1 朱士军2 　　（1上海市金山区亭林镇社区卫生服务中心 上海 201505） 　　（2上海市金山区中心医院消化内科 上海 201500） 　　【摘要】 目的：探讨胃食管反流病（GERD）患者误诊为冠心病原因，以避免临床出现误诊误治现象。方法：收集2007年6月-2013年12月门急诊GERD 患者误诊为冠心病26例，对临床误诊资料实施回顾性分析。结果：本组26例均有胸痛症状，伴放射痛7例，反酸、烧心6例，咳嗽2例。误诊为心绞痛23例，急诊心肌梗塞3例。误诊后，对患者实施胃镜检查，最终有效确诊GERD。应用质子泵抑制剂以及胃肠动力药治疗，患者的临床症状表现显著改善。结论：以胸痛为主要临床表现的GERD容易被误诊为冠心病，应对患者实施胃镜检查等相关的实验室检查，有效与冠心病等鉴别，防止误诊误治。 　　【关键词】 胃食管反流；GERD；误诊；冠心病 　　【中图分类号】R573 【文献标识码】A 【文章编号】2095-1752（2015）17-0215-02 　　【Abstract】Objective To explore the clinical misdiagnosis reason of gastroesophageal reflux disease (GERD) with coronary heart disease, in order to avoid the appearance of misdiagnosis and mistreatment phenomenon in clinic. Methods 26 GERD patients from both outpatient and emergency departments who were misdiagnosed with coronary heart disease were selected from July 2007 to December 2013, the clinical misdiagnosis data of these cases were analyzed retrospectively. Results All 26 patients had chest pain, 7 cases with radiating pain, 6 with reflux and heartburn, 2 with cough. 23 cases were misdiagnosed as angina pectoris, and the other 3 as acute myocardial infarction. After misdiagnosis, patients were examined with gastroenoscopy and were finally effectively diagnosed with GERD disease. Taking proton pump inhibitors and prokinetic drugs as treatment, the clinical symptoms were significantly improved. Conclusions For GERD patients whose main clinical manifestation are chest pain can easily be misdiagnosed as coronary heart disease, gastroscopy and other related laboratory examinations should be implemented so as to distinguish from coronary heart disease and prevent misdiagnosis or mistherapy. 　　【Key words】Gastroesophageal reflux disease; GERD; misdiagnosis; Coronary heart disease 　　胃食管反流病（gastroesophageal reflux disease, GERD）是由胃内容物反流入食管引起的烧心、反酸、胸痛、咳嗽等不适症状和（或）并发症的一种疾病[1]，在我国发病率约为3.1%[2]。烧心、反酸和腹痛是GERD的典型临床表现，而部分患者症状不典型，以胸痛为主要临床表现，往往易被误诊为冠心病。本文选取2007年6月-2013年1