胸痛講課

1、胸痛的診斷及鑒別診斷,五康劉玉冰2018.10,胸痛,Chest pain appears in many forms, ranging from a sharp stab to a dull ache. Sometimes chest pain feels crushing or burning. In certain cases, the pain travels up the neck, into the jaw, and the

2、n radiates to the back or down one or both arms.Many different problems can cause chest pain. The most life-threatening causes involve the heart or lungs. Because chest pain can indicate a serious problem, it's impo

3、rtant to seek immediate medical help.,胸部感覺(jué)神經(jīng)纖維,肋間神經(jīng)感覺(jué)纖維支配主動(dòng)脈的交感神經(jīng)纖維支配氣管與支氣管的迷走神經(jīng)纖維膈神經(jīng)的感覺(jué)纖維,病因,.,Gastroesophageal disease 42 Gastroesophageal reflux Esophageal motil

4、ity disorders Peptic ulcer GallstonesIschemic heart disease 31Chest wall disease 28Pericarditis

5、 4Pleuritis/pneumonia 2Pulmonary embolism 2Lung cancer

6、 1.5Aortic aneurysm 1Aortic stenosis

7、 1Herpes zoster 1,Diagnosis percentage,Different diagnosis of patients admitted to hos

8、pital with acute chest pain ruled not myocardial infarction. Fruergaard P et. al: Eur Heart J 17:1028,1996,胸痛的分類與常見(jiàn)病因,胸痛規(guī)范化評(píng)估與診斷中國(guó)專家共識(shí)ppt,鑒別要點(diǎn),發(fā)病年齡胸痛部位胸痛性質(zhì)持續(xù)時(shí)間影響因素伴隨癥狀,問(wèn)診要點(diǎn)1、起病緩急、胸痛部位、范圍大小、放射部位、疼痛嚴(yán)重度和對(duì)患者的影響2、胸痛性

9、質(zhì)、輕重及持續(xù)時(shí)間、發(fā)生的誘因、加重與緩解方式，咳嗽/深呼吸的影響，與活動(dòng)、進(jìn)餐、情緒的關(guān)系3、有無(wú)發(fā)熱/咳嗽/咳痰/咯血/心悸/發(fā)紺/呼吸困難及其程度4、是否伴有呼吸困難/吞咽時(shí)疼痛加重與反酸5、其他如職業(yè)/嗜好/既往發(fā)作情況及其誘因、緩解方式等,臨床診斷學(xué) 第二版,胸痛部位,胸壁疾病——常固定性、壓痛、炎癥性表現(xiàn)帶狀皰疹——水皰沿肋間神經(jīng)分布伴劇痛肋軟骨炎——第1、2肋軟骨處單個(gè)或多個(gè)隆起、局部壓痛、無(wú)紅腫夾層動(dòng)脈瘤——

10、多位于胸背部，向下放射至下腹部、腰部、兩側(cè)腹股溝和下肢胸膜炎——胸側(cè)部食管及縱隔——胸骨后肝膽疾病及膈下腫瘤——右下胸，右肩部肺尖部肺癌——肩部/腋下為主，向上肢內(nèi)側(cè)放射,心絞痛,多40歲以上，危險(xiǎn)因素胸骨后和心前區(qū)、劍突下、左肩、左臂內(nèi)側(cè)或左頸、左側(cè)面頰與咽部絞榨樣、重壓窒息感，MI更劇烈伴恐懼、瀕死感時(shí)間短暫，含服硝酸酯類藥物后緩解,腹痛-肝與膽囊,內(nèi)臟大神經(jīng)胸脊節(jié)7~8右上腹及右肩胛,肺栓塞篩查量表,注：0-3分

11、低度可疑，4-10分中度可疑，11+分高度可疑,主動(dòng)脈夾層篩查量表,tips,Chest pain：There is little correlation between the severity of chest pain and the seriousness of its cause. The range of disorders that cause chest discomfort is shown in table31-