非手术、非制动超高龄患者多发肺栓塞的误诊分析

Misdiagnosed Analysis of Multiple Pulmonary Embolism in Super Elderly Patients without Operation and Braking

目的分析非手术、非制动超高龄患者多发肺栓塞的误诊原因,加强对疾病临床特点的认识,提高救治水平。方法对2018年12月—2020年12月4例年龄>85岁多发肺栓塞误诊患者的临床资料进行回顾性分析。结果本组误诊率为6.15%。既往有慢性心肺疾病者3例,身体健康者1例。本组出现胸闷2例,气短2例,痰中带血1例,晕厥1例;轻度低氧血症、中度低氧血症、Ⅰ型呼吸衰竭各1例;心电图ST-T改变2例,T波倒置2例,S_(Ⅰ)Q_(Ⅲ)T_(Ⅲ)仅1例。被误诊为左肺上叶肺炎、低氧血症、晕厥、急性胃肠炎各1例,误诊时间3 d~2个月。4例CT肺动脉血管造影均提示双侧多发肺栓塞,以右侧为主;其中2例为大面积肺栓塞。3例给予利伐沙班等治疗,均好转出院;1例肺癌合并肺栓塞放弃治疗。结论超高龄多发肺栓塞患者临床表现无特异性,且多数患者缺乏典型三联征,容易误诊。全体医生均应提高对肺栓塞疾病的认识,拓宽诊疗思维,尤其是合并心肺疾病及D-二聚体、纤维蛋白原降解产物均有升高的超高龄患者,需提高警惕。

Objective To analyze misdiagnosed causes of multiple pulmonary embolism in super elderly patients without operation and braking in order to strengthen the understanding of clinical characteristics of the disease,and to improve the level of treatment.Methods Clinical data of 4 misdiagnosed patients with multiple pulmonary embolism aged more than 85 years old between December 2018 and December 2020 was retrospectively analyzed.Results The misdiagnosed rate was 6.15%.There were 3 patients with chronic cardiopulmonary disease and 1 patient that was previously healthy.There were 2 patients with dyspnea,2 patients with shortness of breath,1 with blood in sputum and 1 with syncope;there were 1 patient with mild hypoxemia,1 with moderate hypoxemia and 1 with type I respiratory failure;ST-T changes in 2 patients,T wave inversion was found in 2 patients,and S_(Ⅰ)Q_(Ⅲ)T_(Ⅲ) was found in only 1 case by ECG(electrocardiography).They were 1 patient misdiagnosed as having left upper lobe pneumonia,1 as having hypoxemia,1 as having syncope and 1 as having acute gastroenteritis respectively.The misdiagnosed duration was 3 d to 2 months.CT pulmonary angiography in 4 patients showed bilateral multiple pulmonary embolism,mainly on the right side.Two of them had massive pulmonary embolism.Three patients were treated with Rivaroxaban,and all improved and discharged.One patient with lung cancer complicated by pulmonary embolism gave up treatment.Conclusion Clinical manifestations of super elderly patients with multiple pulmonary embolism are nonspecific,and most patients lack typical triad,which is more likely to be misdiagnosed.All doctors should improve their understanding of pulmonary embolism and broaden their thinking on diagnosis and treatment,especially for super elderly patients with cardiopulmonary disease and elevated D-dimer and fibrinogen degradation products.