【摘要】 目的：探讨无痛性心肌梗塞(PMI)的临床特点；核素心肌显像(ECT)与冠状动脉造影(CAG)对其诊断价值。方法：300例住院心肌梗塞患者,其中男196例,女104例。有胸痛者234例,无胸痛者66例。同时行 ECT 和冠脉造影检测,将结果进行对比分析。结果：(1)PMI 患者的女性比例、年龄、体重指数及糖尿病、高脂血症的发病率等指标均高于有胸痛组(P＜0.05～＜0.001)；(2)临床症状：心衰、胃肠道症状、低血压或休克、脑卒中、异位疼痛等症状在两组间均存在显著差异(P＜0.05～＜0.001)；(3)心肌酶学、TnT、ECG 在无痛组阳性率明显低于有痛组 (P＜0.001)；(4)ECT 与 CAG 两组间阳性率无差异；(5)PMI 组的误诊(27.27%)、漏诊(25：76)及住院死亡率明显高于有痛性心肌梗塞组(均为0%),P＜0.01。结论：(1)ECT 是一种无创、方便、费用低的早期诊断 PMI 的重要方法；(2)动态观察心电图的变化是减少 PMI 误诊和漏诊的方便手段之一。更多还原

【Abstract】 Objective:To study(1)Clinical characteristic of painless myocardial infarction(PMI);(2)The diagnosis value of single photon emission computed tomography(SPECT)and coronary angiography(CAG)on PMI.Methods: A total of 300 acute myocardial infarction(AMI)patients were examined SPECT and CAG,among them 234 with chest pain(CPMI)and 66 without,then analyzed the check reports.Results:(1)The female,elder,higher BMI, incidence rate of diabetes and hyperlipemia in PMI were more than those of CPMI group(P＜0.05～＜0.001);(2) There were significant difference between two groups in clinical symptoms(P＜0.001);(3)The PMI group had lower positive finding rate in enzymology,ECG examination than those of CPMI group(P＜0.001);(4)The positive finding rates in SPECT and CAG examination were no differences between two groups;(5)The misdiagnosis rate(27.27%) and miss diagnosis rate(25.76%)of PMI group were more than those of CPMI group(P＜0.01).Conclusion: (1)SPECT is a non-invasive,convenient,less cost and important examination method for earlier diagnosis of PMI; (2)ECG examination can reduce the misdiagnoses of PMI.更多还原