28例老年人肺栓塞临床分析及误诊原因探讨

Retrospective study of 28 cases of elderly pulmonary embolism and the discussion of misdiagnosis

目的 提高对肺栓塞的认识并探讨误诊原因。 方法 通过临床表现、实验室检查、X线胸片、肺核素显像等方法 ,对 2 8例老年人肺栓塞患者进行回顾性分析 ,并比较了老年肺栓塞与非老年肺栓塞患者在病因学、临床表现及误诊方面的差异。 结果 老年人易发肺栓塞的因素为 :下肢深静脉血栓、恶性肿瘤、外科手术及创伤、卧床 >3d和高血压等 ,老年组肺栓塞的误诊率高于非老年组 ,误诊率高达 6 0 7% ,最易误诊为肺炎 ,其次为心肌梗死。医师的认识不足是造成误诊的主要原因。 结论 肺栓塞在老年人中常见且容易造成误诊 ,应引起临床医师的充分重视。

Objective To focus on the understanding of pulmonary embolism and to discuss the reasons of misdiagnosis for pulmonary embolism. Methods Retrospective analysis of clinical, instrumental and laboratory examinations of patients (≥60 years old) with pulmonary embolism proven by lung radionuclide images, pulmonary artery angiograms, and chest radiography, etc. In addition, the differences in etiology, clinical manifestations and misdiagnosis between senile and non senile patient were compared. Results The risk factors for pulmonary embolism in elderly people included deep venous thrombosis, malignant neoplasm, history of operation, sick bed over 3 days, etc. The rate of misdiagnosis in the elderly was 60 7% and the main reasons for misdiagnosis was the poor understanding for pulmonary embolism. Conclusions Pulmonary embolism is frequently seen in the elderly and may not be rarely misdiagnosed. Therefore, much more attention should be paid to it.