急性肺栓塞误诊为急性冠状动脉综合征51例分析

Acute pulmonary embolism misdiagnosed as acute coronary syndrome: analysis of 51 cases

目的提高急性肺栓塞诊治水平,减少误诊发生。方法回顾性分析2015年2月至2018年12月收治的51例急性肺栓塞误诊为急性冠状动脉综合征患者临床资料,分析其特点。结果 51例患者及时得到明确诊断,治疗后病情稳定出院,随访1个月无不良事件发生。结论全面仔细分析患者病情,临床表现为胸闷胸痛、心电图提示心肌缺血时,不能只考虑急性冠状动脉综合征,尤其是出现不能解释的低氧血症、呼吸困难,应警惕急性肺栓塞可能,及时作超声心动图、血气分析,必要时行肺血管CT明确诊断。

Objective To improve the diagnosis and treatment level of acute pulmonary embolism(APE) and to reduce the occurrence of clinical misdiagnosis of APE. Methods The clinical data of 51 patients with initial misdiagnosis of acute coronary syndrome, who were admitted to authors’ hospital during the period from February 2015 to December 2018 and were finally proved to be APE, were retrospectively analyzed. Its clinical features were summarized. Results The correct diagnosis was promptly made in all 51 patients. After treatment, the clinical condition of patients was improved and the patients were in a stable condition at the time of discharge from hospital. No adverse events occurred during one-month follow-up observation. Conclusion In order to avoid the misdiagnosis of APE, patient’s clinical condition should be comprehensively and carefully evaluated. Clinically, when a patient complains chiefly of chest tightness and chest pain, and the patient’s electrocardiogram indicates myocardial ischemia, the diagnosis of acute coronary syndrome must not be taken as the only consideration, especially when the patient has unexplained hypoxemia and dyspnea, the possibility of APE should be highly suspected, in such case echocardiography and blood gas analysis, as well as CT pulmonary arteriography if necessary, ought to be promptly carried out so as to make a definite diagnosis.