4. 急性胸痛
概 述
胸痛是主观感觉胸部刺痛、锐痛、钝痛、闷痛或压迫感,常伴有紧张、焦虑和恐惧,是临床常见急诊症状之一。致命性胸痛可能是急性冠状动脉综合征、主动脉夹层、肺栓塞、气胸等,其中以急性冠状动脉综合征最常见。以下是急性胸痛诊治的临床路径。
表4.1 急性胸部疼痛的重点评估
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T4.1_4453.jpg?sign=1739000297-iiF2s7awlm2rgqOvK63CrLsdLFBuaqz6-0-e10914e2285a75e850c68ef620106dfb)
表4.2 ST段抬高型心肌梗死、早期复极综合征和急性心包炎的心电图特征
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T4.2_59943.jpg?sign=1739000297-JZadklQVhNA967AouTDMez7ksHZWeKUK-0-b512151a004c6b314c67f7de2f4044a9)
续表
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T4.2_1_59944.jpg?sign=1739000297-8RnjlsMtaouziagGQqMAMaYhFT5mznnf-0-1f503266133492827805c769447afb40)
表4.3 急性胸痛的病因
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T4.3_59945.jpg?sign=1739000297-geo1AjtjaX1dQVOng3VeiCTnTqc8ypYl-0-a8529e1e887640e1d0ad799f1f044ca5)
表4.4 急性胸痛的紧急检查
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T4.4_4634.jpg?sign=1739000297-xtYuXXCwW7ZRBQapv8TZ5EzTGmusLrYX-0-2a4658847c9a169a793f486344fe9728)
表4.5 心肌标志物
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T4.5_59946.jpg?sign=1739000297-0ptMyN7Y2tIBxT6u4CcvpeZVTT3fwZcZ-0-8f9d71e1cefa6cce59b54f551dd0ca30)
表4.6 肌钙蛋白升高的非冠状动脉因素
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T4.6_59617.jpg?sign=1739000297-CYHhGvpkPpTEXs8H7woThMeksijTriQy-0-84c3b6054c689d731739339b263249bf)