早期左心衰竭误诊肺部疾患20例分析

Pulmonary appearances in patients with early heart failure

目的观察评价慢性心衰患者肺部特殊表现发生情况并探讨其临床意义及病理生理特点。方法对20例以肺部表现为首发症状的慢性心功能不全者的主要临床症状、肺部影像学改变、治疗和转归等综合分析。结果20例中胸闷气短19例,咳嗽15例,咯黄白痰12例,咯血痰1例,大咯血6例,劳力性呼吸困难5例,夜间阵发性呼吸困难7例。心功能分级Ⅰ-Ⅱ级17(85%)例,Ⅲ级3例(15%)。16例(80%)分别以咯血、肺炎、胸腔积液、肺心病、肺部感染入呼吸科。胸片主要表现为双下肺为重的两肺纹理增多、紊乱、模糊,部分伴单侧或双侧胸腔积液。胸腔积液者14例;肺部阴影者8例,其中疑诊为肺癌者3例。咳嗽咳痰、胸水、肺部阴影及咯血经抗生素或缩血管药物治疗效果不佳,改用强心、利尿和/或扩血管治疗后均收到理想效果。结论早期心功能不全的表现极不典型,特别是以肺部表现为主时极易误诊为肺部炎症、肿瘤和支气管扩张。当这些患者有心脏病基础时,应首先除外早期心功能不全,以利及早治疗。

Objective To evaluate the prevalence, clinical significance and pathophysiologic characteristics of pulmonary appearances in patients with early heart failure. Methods The clinical characteristics treatment were reviewed and analyzed in 20 patients with early heart failure. Results Of 20 patients, 19 were with a short breath, 15 with cough, 12 with coughing phlegm and 6 with hemoptysis. The radiographic results showed a manifold misty turbulence venation in the lung. Shadows were found in the lung in 8 patients, of them 3 were diagnosed as carcinoma. And in 70 %, of whom patients pleural effusions were found. All the patients with cough, above symptoms in the lung and with hemoptysis were insensitive to common antibiotics. Significant changes could occur shortly in all of the patients treated with digitalis and vasodilators and duretics, and the shadow and pleural effusions could be absorbed shortly. Conclusion Patients with early heart falture have no typical clinical characteristic, especially those with symptoms in thorax, which are often misdiagnosed as pneumonia, lung cancer or bronchiectasis. For the patients with heart disease, the early heart failure should be first excluded to early treatment.