非典型肺栓塞症临床分析

Clinical analysis of atypical pulmonary embolism

目的分析非典型肺栓塞症误诊的常见原因,提高对非典型肺栓塞症的认识。方法回顾性分析第三军医大学新桥医院及泸州医学院附属医院心血管内科、呼吸内科2006年1月至2013年12月临床确诊的120例非典型肺栓塞症患者的危险因素、临床表现、实验室及影像学检查资料。结果 120例非典型肺栓塞症入院时误诊39例(误诊率32.5%)。误诊为急性冠状动脉综合征8例,冠心病稳定型心绞痛7例,慢性阻塞性肺疾病(COPD)所致慢性肺源性心脏病7例,肺炎5例,胸腔积液3例,肺结核3例,支气管哮喘3例,房间隔缺损1例,急性左心衰竭1例,心源性晕厥1例。结论非典型肺栓塞症因其临床表现缺乏特异性,很容易误诊、误治,临床医师应提高诊断与鉴别诊断水平,对于高度怀疑的患者,应尽早行肺部增强CT或肺动脉CT血管造影等检查,减少对非典型肺栓塞症的误诊。

Objective To analyze the common reasons for misdiagnosis of atypical pulmonary embolism （APE）,and to improve the identification of APE. Methods The risk factors,clinical manifestations,laboratory examinations and radiographic data of 120 cases of APE diagnosed from January 2006 to December 2013 in the department of cardiovascular medicine and respiratory medicine of Xinqiao Hospital and the Affiliated Hospital of Luzhou Medical College were studied retrospectively. ResuLts Among those 120 cases of APE, 39 cases were misdiagnosed on admission （32. 5%）. 8 eases were misdiagnosed as acute coronary syndrome,7 cases as stable angina pectoris,7 cases as chronic cot pulmonale,5 cases as pneumonia,3 cases as pleural effusion,3 cases as tuberculosis, 3 cases as asthma, 1 case as atrial septal defect, 1 case as acute heart failure,and 1 case as cardiogenic syncope. Conclusion APE is easy to be misdiagnosed for its non-specific clinical manifestation. Pulmonary enhanced CT or CTPA should be carried out in time for those highly suspected patients,in order to reduce the misdiagnosis of APE.