【摘要】 目的探讨持续性不卧床腹膜透析(CAPD)患者急性心肌梗死(AMI)时的临床特点。方法1991～2004年在东莞市人民医院和中山大学附属第一医院住院确诊为第一次AMI的39例CAPD患者为透析组,50例非肾功能不全病人为对照组,比较它们的临床症状、体征、心电图演变、心肌酶变化和住院期病死率等临床和实验室资料。结果与对照组相比,透析组的首发症状较不典型;AMI发生后患者就诊时间较迟(P<0.05)。透析组不典型心电图演变(61.5%vs26.0%)和不典型心肌酶变化(90.0%vs12.5%)均较对照组多(P<0.05),但不典型心电图的动态变化均符合AMI的国际诊断标准,而不典型心肌酶变化则不符合。透析组心功能衰竭和肺部感染的发生率均较对照组高(P<0.05)。住院期死亡率透析组高于对照组(69.2%vs6.0%,P<0.05)。结论CAPD患者AMI的临床表现、心电图演变和心肌酶变化均不典型,动态观察心电图是诊断AMI较为可靠的手段;发生AMI后CAPD患者住院期病死率极高。更多还原

【Abstract】 ObjectiveTo investigate the clinical features of acute myocardial infarction in CAPD patients.MethodsCompare the clinical and laboratory data of 39 patients with CAPD and AMI for the first time (PD group),including clinical symptoms,signs,electrocardiogram changes,myocardial enzyme changes and in hospital mortality,with those of 50 patients without renal insufficient but with AMI for the first time (C group).Diagnosis of AMI was made in hospital.ResultsCompared to C group, the symptoms presented at first in PD group were more atypical and the patients went to see doctor more lately after AMI.Atypical electrocardiogram changes were more in PD group than in C group (61.5% vs 26.0%,P<0.05),so were atypical myocardial enzyme changes (90.0% vs 12.5%,P<0.05).However,the series changes of atypical electrocardiogram fulfilled the criteria for AMI,but atypical myocardial enzyme changes did not.The incidence of cardiac function failure or pulmonary infection was higher in PD group than in C group.The mortality in hospital was also higher in PD group.ConclusionThe clinical manifestation,electrocardiogram changes or myocardial enzyme changes are atypical,but the observation of series changes of electrocardiogram may be a more reliable method to diagnose AMI in CAPD patients.The mortality of CAPD patients with AMI in hospital is very high.更多还原