老年肺动脉血栓栓塞误诊70例临床分析

Clinical analysis of misdiagnosis of pulmonary embolism in old patients

目的分析老年肺动脉血栓栓塞(肺栓塞)的特点及误诊原因,以提高对老年肺栓塞的早期识别和处理。方法回顾性分析70例老年肺栓塞误诊患者的临床表现、超声心动图、心肌酶、肌钙蛋白Ⅰ、血气分析、D-二聚体、胸部X线及其他影像等临床资料,总结分析误诊的原因。结果 70例老年肺栓塞患者中,临床表现胸闷、呼吸困难57例(81.4%),胸痛27例(38.6%),咳嗽15例(21.4%),晕厥13例(18.6%),误诊疾病主要为冠心病46例(65.7%),心功能不全7例(10.0%),肺部感染5例(7.1%),慢性阻塞性肺病3例(4.3%),脑梗死3例(4.3%)。肺栓塞临床分类大面积1 9例,次大面积37例,小面积14例。结论老年肺栓塞多合并基础疾病,患者非特异性的临床症状、心电图的改变、肌钙蛋白I及心肌酶的升高、胸部X线浸润阴影为误诊主要原因。

Objective To analyze the clinical characteristics of pulmonary embolism（PE） and its misdiagnosis reasons,so as to improve the early diagnosis and treatment. Methods The clinical characteristics of pulmonary embolism in 70 old patients and their clinical data including UCG, myocardial enzyme, cTnI, blood-gas analysis,D-dimer test and X-ray were analyzed retrospectively. Results Of the 70 old misdiagnosed PE patients, 57 had chest distress and dyspnea, 27 had chest pain,15 had cough, 13 had syncope. Forty-six patients were misdiagnosed as coronary heart disease（65. 7%）,7 patients as heart dysfunction（10. 0%）, 5 patients as pulmonary infection （7.1 % ）, 3 patients as chronic obstructive pulmonary disease（4.3% ）, 3 patients as cerebral infarction（4.3%）. Nineteen patients had massive PE,37 patients had sub-massive PE, 14 patients had small PE. Conclusion Old PE patients were mostly complicated with basic diseases and presented non-specific symptoms. Changes of ECG,increase in myocardial enzyme and cTnI, and infiltration shadow in chest X-ray were main reasons of misdiagnosis.