慢性阻塞性肺疾病并发自发性气胸漏诊、误诊临床分析

Clinical analysis of missed diagnosis and misdiagnosis on patients with chronic obstructive pulmonary disease complicated by spontaneous pneumothorax

目的探讨慢性阻塞性肺疾病合并自发性气胸的临床诊断思路,减少漏诊、误诊发生,提高临床诊治质量。方法从1061位自发性气胸患者选出合并COPD患者816,其中漏诊、误诊患者31例,本研究全面分析COPD合并自发性气胸漏诊、误诊发生率及其原因。结果COPD合并自发性气胸漏诊和误诊率为2.9%。产生的原因有:体征不典型;医务人员对气胸警惕性差,未拍X线胸片或某些X线检查难以发现,合并存在其他心脏病时易造成思路偏倚误诊为急性左心衰等。结论AECOPD患者突发呼吸困难,端坐呼吸等急症时,医务工作者一定有合并气胸的警惕性,详细询问病史,仔细查体,应常规作X线胸片检查,必要时作胸部CT检查,以明确诊断,避免AECOPD合并气胸的漏诊或误诊。

Objective To investigate the diagnosis of chronic obstructive pulmonary disease, to reduce the missed diagnosis, misdiagnosis, and to improve the quality of clinical diagnosis and treatment. Methods 816 patients with COPD combined spontaneous pneumothorax were elected from 1061 patients with spontaneous pneumothorax. Among them 31 cases bad missed diagnosis or misdiagnosis. The rate of missed diagnosis or misdiagnosis and the reasons behind it were examined. Results The rate of misdiagnosis and missed diagnosis on patients with COPD combined spontaneous pneumothorax was 2. 9%. The causes included： symptoms were not typical; medical personnel ignored the pneumothorax, did not take X-ray or not conduct x-ray examination, other heart disease complicated to lead to the misdiagnosis as acute left ventricular failure, and so on. Conclusion When AECOPD patients with sudden difficulty in breathing, medical workers must be given sufficient attention, including asking about the patients illness history in details, careful physical inspection, and routine X-ray inspection, if necessary, for the chest CT check, to avoid the misdiagnosis or the missed diagnosis.