摘要
目的提高肺动脉栓塞（pulmonaryembolism，PE）首诊检出率。方法回顾楚雄州医院2013年9月～2015年5月第一诊断为PE的40例患者的临床资料、对比相近时期门诊死亡情况，寻找误诊、漏诊原因，评价辅助检查价值，阐明相关病理生理，提出首诊建议。结果肺栓塞临床表现复杂多样，缺乏特异性，误诊率高，首诊误诊31例占77．5％。误诊病种以肺炎居多，有9例（22．5％）；其次是冠心病5例（12．5％）、心衰5例（12．5％）、慢性阻塞性肺病（chronic obstructive pulmonarydisease，COPD）4例（10．0％）、下肢深静脉血栓（deepvein thrombosis，DVT）3例（7．5％）、胸水2例（5．0％）。PE检出率由高到低的专业依次为：血管外科3例占50％、急诊科2例占20％、内科（心内科＋呼吸科＋老年病科＋内科门诊）4例占19％。与肺栓塞误诊不降并存的是门诊猝死率不降。故门诊猝死病例中可能包含大量被误诊的肺栓塞患者。结论目前的肺动脉栓塞检出率远低于流行病学统计，误诊漏诊较多，医疗风险较大。误诊肺炎居首位，应加强肺炎表象中的肺动脉栓塞筛查。
Objective To improve the initial diagnosis detection rate of pulmonary embolism （PE）. Methods A total of 40 patients diagnosed with PE in our hospital from September 2013 to May 2015 were reviewed; Outpatient deaths were compared in the similar period, the causes of misdiagnosis and in diagnosis were looking for,and the physical and chemical inspection were evaluated, relevant pathological physiology was clarified, the advice of the initial diagnosis was put forward. Results The clinical manifestations of pulmonary embolism were complicated and lack of specificity, the misdiagnosis rate of pulmonary embolism was high. Misdiagnosis was 31 cases （77.5%）, misdiagnosed diseases was in turn： pneumonia was 9 cases （22.5%）,coronary heart disease was 5 cases （12.5%）, heart failure was 5 cases （12.5% ）, COPD was 4 cases（10.0%）, DVT was 3 cases （7.5%）, pleural effusion was 2 cases （5.0%）. The detection rate of PE in the order： vascular surgery was 3 cases（50%）, emergency department was 2 cases（20%）, the medical department （cardiology department＋respiratory department＋geriatric departments＋outpatient department of internal medicine） was 4 cases （19%）. Patients were misdiagnosed as pulmonary embolism and patients diagnosed as sudden death in outpatient service was more. So a lot of patients should be diagnosed as pulmonary embolism may be misdiagnosed as sudden death. Conclusion The detection rate of pulmonary embolism is far lower than the epidemiology statistics,there are many misdiagnosis and in diagnosis,medical risk is bigger. The probability of PE being misdiagnosed as pneumonia is for the first, PE should be screened from pneumonia cases.
出处
《中国现代医生》
2016年第4期84-87,共4页
China Modern Doctor
关键词
肺动脉栓塞
肺炎
误诊
漏诊
Pulmonary embolism
Pneumonia
Misdiagnosis
Missed diagnosis
