基层医院对肺栓塞的认识

Cognition of pulmonary embolism in primary hospital

目的分析肺栓塞(PE)的误诊原因,以期提高基层医院对PE的认识。方法回顾性分析20例PE误诊患者的临床资料及误诊原因。结果 PE患者早期以胸痛及胸闷、呼吸困难、咳嗽、心悸等为主要临床表现,缺乏特异性。PE患者的主要影像学及实验室特征为:新发性肺部浸润影、窦性心动过速、肺动脉高压、D-二聚体阳性、血氧分压降低。20例PE患者被误诊为心脏疾病及呼吸系统疾病的构成比分别为45.00%、55.00%。20例患者经治疗,痊愈4例,占20.00%;好转13例,占65.00%;无变化1例,占5.00%;死亡2例,占10.00%。结论 PE的早期临床表现缺乏特异性,极易被误诊为心脏疾病及呼吸系统疾病;临床上,医师应提高对PE的认识,对于出现新发性肺部浸润影、窦性心动过速、肺动脉高压、D-二聚体阳性、血氧分压降低者,应考虑可能出现PE,以提高PE诊断准确率。

ObjectiveTo analyze causes of misdiagnosis for pulmonary embolism （PE）, in order to improve cognition of PE in primary hospital.MethodsA retrospective analysis was made on clinical data and misdiagnosis causes of 20 PE patients.ResultsMain clinical symptoms in early PE patients included chest pain, chest distress, dyspnea, cough and palpitation, without specificity. Main imaging and laboratory features of PE patients included newly onset pulmonary infiltration image, nodal tachycardia, pulmonary hypertension, positive D-dimer, and reduced partial pressure of blood oxygen. Proportion of misdiagnosed heart diseases and disease of respiratory system in 20 PE patients were respectively 45.00% and 55.00%. Among the 20 cases, there were 4 cured cases, accounting for 20.00%, 13 improved cases, accounting for 65.00%, 1 case without change, accounting for 5.00%, and 2 death cases, accounting for 10.00%.ConclusionDue to lack of specificity in early PE clinical manifestations, it is easily misdiagnosed as heart diseases and disease of respiratory system. Clinicians should improve cognition of PE, and consider possibility of PE in patients with newly onset pulmonary infiltration image, nodal tachycardia, pulmonary hypertension, positive D-dimer, and reduced partial pressure of blood oxygen, so as to improve accuracy of PE diagnosis.