1、胸痛的诊断及鉴别诊断 五康刘玉冰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 then radiates to the back or down one or both arms. Many different problems can caus
2、e chest pain. The most life-threatening causes involve the heart or lungs. Because chest pain can indicate a serious problem, its important to seek immediate medical help.胸部感觉神经纤维肋间神经感觉纤维支配主动脉的交感神经纤维支配气管与支气管的迷走神经纤维膈神经的感觉纤维病因.Gastroesophageal disease 42Gastroesophageal reflux Esophageal motility diso
3、rdersPeptic ulcerGallstonesIschemic heart disease 31Chest wall disease 28Pericarditis 4Pleuritis/pneumonia 2Pulmonary embolism 2Lung cancer 1.5Aortic aneurysm 1Aortic stenosis 1Herpes zoster 1 Diagnosis percentage Different diagnosis of patients admitted to hospital with acute chest pain ruled not m
4、yocardial infarction. Fruergaard P et. al: Eur Heart J 17:1028,1996胸痛的分类与常见病因胸痛规范化评估与诊断中国专家共识ppt鉴别要点发病年龄胸痛部位胸痛性质持续时间影响因素伴随症状问诊要点1、起病缓急、胸痛部位、范围大小、放射部位、疼痛严重度和对患者的影响2、胸痛性质、轻重及持续时间、发生的诱因、加重与缓解方式，咳嗽/深呼吸的影响，与活动、进餐、情绪的关系3、有无发热/咳嗽/咳痰/咯血/心悸/发绀/呼吸困难及其程度4、是否伴有呼吸困难/吞咽时疼痛加重与反酸5、其他如职业/嗜好/既往发作情况及其诱因、缓解方式等临床诊断学 第二版胸痛部位胸壁疾病常固定性、压痛、炎症性表现带状疱疹水疱沿肋间神经分布伴剧痛肋软骨炎第1、2肋软骨处单个或多个隆起、局部压痛、无红肿夹层动脉瘤多位于胸背部，向下放射至下腹部、腰部、两侧腹股沟和下肢胸膜炎胸侧部食管及 胸骨 疾病及膈下肿瘤 下胸， 部 部 部/ 下 主，向 肢侧放射
