56例老年肺栓塞患者心电图特点及临床资料分析

ECG characteristics and clinical datum analysis of 56 aged patients with pulmonary embolism

目的:探讨老年人肺栓塞的临床特点及诊断。方法:对56例老年人肺栓塞的临床特点、心电图及诊断进行总结分析。结果:老年肺栓塞患者最常见症状为劳力性呼吸困难,有39例(69.6%),心电图有特征性变化12例(21.4%),56例患者行多层螺旋CT肺动脉造影,均发现肺动脉内血栓(100%);核素肺通气灌注扫描38例,提示有肺灌注与通气显像不匹配32例(84.2%);下肢深静脉超声发现静脉血栓26例(46.4%)。误诊情况:误诊26例(46.4%),误诊:呼吸系统疾病14例(53.8%),其中感染性休克8例,肺部感染6例;误诊为循环系统疾病12例(46.2%),其中急性冠状动脉综合征5例,心力衰竭4例,心源性休克3例。结论:老年人肺栓塞最常见症状为劳力性呼吸困难,少数患者心电图有特征性变化,肺动脉造影为主要确诊手段。

Objective：To explore clinical characteristics and diagnosis in aged patients with pulmonary embolism. Methods：The data of electrocardiogram （ECG）,clinical characteristics and diagnosis were summarized and analyzed in 56 aged patients with pulmonary embolism.Results：The most frequent symptom was exertional dyspnea （69.6%）.ECG had characteristic changes in 12 patients （21.4%）.All 56 patients received multi-slice spiral CT pulmonary arteriography,and thrombus within pulmonary artery was found in all patients （100%）;38 cases received nuclide lung ventilation perfusion scanning,the results were 32 cases （84.2%）with mismatching pulmonary perfusion and ventilation imaging;Ultrasound examine found there were phlebothrombosis in deep vein of lower limb of 26 cases （46.4%）.Misdiagnosis：The 26 cases （46.4%）were misdiagnosed.A total of 14 cases （53.8%） were misdiagnosed as respiratory system diseases,including eight cases of infectious shock and six cases with pulmo-nary infection;12 cases （46.2%）were misdiagnosed as circulatory system diseases,including five cases of acute coronary syndrome,four cases of heart failure and three cases of cardiogenic shock.Conclusion：The most frequent symptom is exertional dyspnea in aged patients with pulmonary embolism;ECG has characteristic changes only in few patients;the pulmonary arteriography is major diagnosis method.