课件：急性腹胸痛.pptVIP

Hemoptysis: tuberculosis, pulmonary embolism and primary lung cancer. 胸痛常伴有咯血：肺结核、肺栓塞、原发性肺癌。 Sneeze: brustwirble disease 胸痛常伴有深吸气或打喷嚏加重：胸椎病变 Simultaneous phenomenon of chest pain 胸痛的伴随症状 Hypertention and/or history of coronary heart disease: angina pectoris, myocardial infarction 胸痛常伴有高血压和 (或) 冠心病史：心绞痛、心肌梗死 Dyspnea: pneumonia, pneumothorax, pleurisy, pulmonary embolism and hyperventilation syndrome, etc. 胸痛常伴有呼吸困难：肺炎、气胸、胸膜炎、肺栓塞、过度换气综合征等 Abatement position: cardiopericarditis:sitting up and leaning forward; esophageal hiatal hernia: erect position 胸痛常伴有特定体位缓解：心包炎－坐位及前倾位；食管裂孔疝－立位 Simultaneous phenomenon of chest pain胸痛的伴随症状 Onset suddenly: thoracic organ rupture is conclued by the symptoms of rapid severe chest pain.such an dissection of aorta, aerothorax,and mediastinal emphysema etc. 胸痛伴起病急剧，胸痛迅速达高峰，往往提示胸腔脏器破裂，如主动脉夹层、气胸、纵隔气肿等 THANK YOU SUCCESS * * 可编辑 Haemodynamics: fatal symptoms are appeared as hypotension/venous engorgement such as pericardial tamponade, acute myocardial infarction，severe pulmonary embolism , dissection of aorta 胸痛伴血流动力学异常－低血压／及静脉怒张则提示致命性胸痛（心包填塞、急性心肌梗塞、巨大肺栓塞、主动脉夹层） Evaluation Cardiogenic Chest Pain心源性胸痛的急诊评价方法 History and physical examination 病史、查体 12 Leads-ECG (Dynamic Observation)- myocardial ischemia (30%) increase ST 12导 ECG(动态观察)---心肌缺血(30%)ST抬高 Chest pain without typical ECG change: serum myocardium maker\ treadmill exercise \ UCG \ nuclear cardiology (Non-abnormal 50% AMI during the diagnose of 20%AMI) – dynamic oberservation 对ECG无明显变化的胸痛-血清标志物检查\运动平板\UCG\核素检查(50%AMI的ECG无异常---观察期间20%AMI)--动态观察—易误诊  Evaluation on Cardiogenic Chest Pain心源性胸痛的急诊评价方法 Cardiac marker testing (TNT、TNI、CPK-MB、 GOT、 LDH) 血清标志物检测(TNT、TNI、心肌酶谱) CTNT forecasts the acute myocardial ischemia CTNT是急性心肌缺血独立危险预报因子 Radionuclide ：myocardial ischemia after six hours 核素心肌缺血或梗死6小时后 Identified as non-cardiac chest pain if ECG does not change through observation 若胸痛经动态观察ECG等无变化，考虑非心源性胸痛。 Characters of chest pain in emergency急诊常见疾病的胸痛特点 心绞痛Ang