急性肺动脉栓塞误诊原因分析

To analyze the misdiagnose cause of pulmonary embolism

目的研究如何快速、准确、简易的对急性肺动脉栓塞(PE)做出诊断,以便急诊更好及早诊断。方法回顾性总结28例误诊病例的发病原因、临床表现、体征、实验室及影像检查。结果急性肺动脉栓塞易误诊为心绞痛、心衰、肺炎等疾病。主要的临床表现为呼吸困难92.4%、心悸64.4%。血气分析、D-Dimer可作为筛选手段。阳性率:PaO271.9%、PCO242.8%、pH57.1%、D-Dimer85.7%。超声心动图能较明确反映PE的右室负荷增加征象,三尖瓣关闭不全64.3%、右室扩大85.7%、肺动脉高压57.1%。结论急诊工作中对呼吸困难、心悸、胸痛症状的患者应提高对警惕。详细的问诊及体检有利于鉴别。血气分析、D-Dimer、超声心动图是快速、易行、有效的筛查PE的手段。

Objective To research fast,accurate and practical methods for diagnosis of acute pulmonary embolism in emergency department. Methods 28 cases of misdiagnosed PE were involved in this study.The pathogenesis,clinical symptoms,signs,lab examination and examination instruments were retrospectively analyzed,Results PE was easy to mlsdiagnosed with angina pectoris,heari failure,pneumonia.Common clinical symptoms were short of breath 92.4%, palpitation 64.4%.The blood gas analysis and D-Dimer test were the primary screening methods for PE.Positive rate of PaO2 71.9% ,PCO2 42,8% ,pH 57.1% ,D-Dimer 85,7%.UCG was able to clearly feature the increased right ventricular load. Tricuspid incompetence 64.3%, right ventricular enlargement 85.7% ,pulmonary artery high pressure 57.1%.Conclusions Patients who suffer form short of breath, palpitation,chest pain in emergency department should be alerted of PE. Detailed disease history and physical examination should be taken to distinguish with PE.The blood gas analysis,D-Dimer test and UCG are fast, practical,effective methods for diagnosis of PE.