老年性肺栓塞误诊原因分析

Misdiagnosed Causes of Elderly Patients with Pulmonary Embolism

目的分析老年性肺栓塞的误诊原因,并总结防范措施。方法选取2019年3月—2020年4月误诊的老年性肺栓塞8例的临床资料。结果本组误诊率为2.99%。8例中有3例主要表现为咳嗽、咳痰、发热,可见痰中带血、胸痛;5例表现为胸闷、气短,在活动后上述症状加剧。3例误诊为肺炎,5例误诊为不稳定型心绞痛。误诊时间为2~12(5.18±1.55)d。经对症治疗后患者临床症状未改善,进一步行肺血管重建检查确诊为肺栓塞,给予溶栓、抗凝等内科综合治疗后患者均康复出院。结论在诊断过程中临床医生对患者病史了解不足,缺乏对肺栓塞的警惕性,缺乏综合思维,以及肺栓塞缺乏临床特异性表现是导致老年性肺栓塞误诊的重要原因。

Objective To analyze misdiagnosed causes of elderly patients with pulmonary embolism(PE)and to summarize preventive measures.Methods Clinical data of 8 misdiagnosed elderly patients with PE between March 2019 and April 2020 was selected.Results The misdiagnosed rate was 2.99%.Among the 8 elderly patients,3 patients had main manifestations as cough,expectoration,fever,blood in sputum and chest pain;5 patients had manifestations as dyspnea and shortness of breath,which aggravated after activity.Three patients were misdiagnosed as having pneumonia,and 5 as having unstable angina pectoris.The misdiagnosed duration was 2-12(5.18±1.55)d.After symptomatic treatment,patients'clinical symptoms did not improve,and PE was confirmed after further examination of pulmonary revascularization.After comprehensive treatments such as thrombolysis and anticoagulation,and the patients were discharged from the hospital after recovery.Conclusion In the process of clinical diagnosis,clinicians have insufficient knowledge of the patient's medical history,lack of vigilance for PE,insufficient use of comprehensive thinking,and lack of clinical specific manifestations of PE are important reasons for misdiagnosis of elderly patients with PE.