中国肺动脉栓塞误诊近四年文献分析

Pulmonary embolism misdiagnosis in China: a literature review (2001 to 2004)

目的研究中国目前阶段肺动脉栓塞（PE）误诊状况，旨在调查我国目前PE误诊状况发生的变化。方法通过中国期刊网中国医院知识仓库（CNKI-CHKD）检索2001-2004年发表与PE误诊有关的病例研究报告，对被误诊患者一般情况、治疗及转归、死亡原因、发表文献医院级别、误诊疾病等进行了回顾性调查研究，与1980-2000年的误诊情况作了比较，并调查了1994-2004年每年发表有关PE所有文献与误诊文献篇数变化的趋势。结果（1）经检索后共筛选出误诊文献110篇，累计报告PE误诊患者1540例，误诊时间0．5小时～16年，平均1．86年，涉及临床、诊断技术多个科室。（2）首诊误诊经确诊后进行有效干预（抗凝、溶栓）组，有效率高于误诊后未干预（内科保守治疗）组（OR为11．67，95％CI5．861-23．249），病死率低于未干预组（OR为0．19，95％C10．084-0．412）。未干预组死亡原因主要为猝死、休克难以纠正等，干预组死亡原因为猝死、脑出血、休克等。（3）省级医院、地市级医院、县级医院、乡镇厂矿医院等报告误诊文献篇数与误诊病例数量分别为37篇547例（33．6％、35．5％）、43篇671例（39．1％、43．6％）、23篇265例（20．9％、17．2％）、3篇34例（2．7％、2．2％）。（4）1994--2004年发表有关PE的文献与误诊文献篇数逐年增多，平均每年递增分别为26．6％、9．1％。（5）被误诊疾病多达70余种，前4位依次是：冠心病449例次（26．8％）、肺炎217例次（12．9％）、充血性心力衰竭142例次（8．5％）、胸膜炎114例次（6．8％）。结论（1）误诊原因与首诊医师对病情不能充分认识有关，被误诊的患者若不能尽快确诊而进行有效干预则严重威胁其健康。（2）与1980-2000年比较，PE误诊疾病次序已有所变化，但冠心病与肺炎仍占据误诊疾病的前两位，应加强PE与两种疾病问的鉴别诊断能力。（3）中国医生对PE及其误诊的重视程度已有明显提高，但基层医院医师的认识水平有待进一步加强，应加强我国临床医师对肺栓塞知识继续教育普及的力度．我国防治PE的仟备仍仟萤而诺沅．

Objective To evaluate the present status of pulmonary embolism （PE） misdiaguosis in China. Methods Documents on PE misdiaguosis published in Chinese-language journals between 2001 and 2004 were identified by searching the China Hospital Knowledge Database in China National Knowledge Infrastructure Web （CNKI-CHKD）. Retrospective review items include： patient symptoms, medical examination tools, treatments and prognosis, causes of death, hospitals involved. The recent situation on PE misdiaglaosis was also compared to that in year between 1980 to 2000. The number of published literatures on PE and PE misdiaglaosis from 1994 to 2004 was also searched. Results （ 1 ） A total of 110 documents with 1540 misdiaglaosed PE patients were found. The misdiagnosis time varies from 0. 5 hour to 16 years and was 1.86 years on average. （2） Once the misdiagnosis be corrected, the prognosis could be improved by antithrombotic and thrombolytic therapies compared with those without antithrombotic and thrombolytic therapies （OR 11.67,95% CI 5. 861-23. 249）. The major causes of death were sudden death, resistant shock in patients without antithrombotic and thrombolytic therapies while the causes were sudden death, cerebral hemorrhage and resistant shock in PE patients received antithrombotic and thrombolytic therapies. （ 3 ） Literatures on PE misdiagnosis were most from provincial hospitals [ 37 papers with 547 cases （ 33.6%, 35.5% ） ] and municipal hospitals [43 papers with 671 cases （39. 1% ,43.6% ） ]. （4） The number of papers published on PE and PE misdiagnosis from 1994 to 2004 increased steadily by an average of 26. 6% and 9. 1% , respectively. （5） PE was misdiagnosed to more than 70 kinds of diseases and the top 4 were coronary heart disease in 449 cases （26. 8% ）, pneumonia in 217 cases （ 12. 9% ）, congestive heart failure in 142 cases （ 8. 5% ） and pleurisy in 114 cases （ 6. 8% ）. Conclusions （ 1 ） PE misdiagnosis is still a critical issue now in China and early diagnosis and effective treatment is essential for a better prognosis. （2） The differential diagnosis among PE and coronary heart disease and pneumonia need to be emphasized to avoid the PE misdiagnosis. （3）Efforts should be made through continuing education on clinical professionals to improve their knowledge on PE in China.