心肺疾病老年人并发肺栓塞的误诊分析.docVIP

【摘要】 目的：提高对患心、肺系统疾病老年人并发肺栓塞的认识，探讨及时确诊措施。方法：总结23例老年人肺栓塞的临床表现、实验室检查、影像检查等诊断资料。结果：78%患者表现突发性呼吸困难，以晕厥为首发症状者5例（217%），100%有低氧血症，10例行下肢静脉造影者中8例有下肢静脉血栓，14例核素肺扫描和18例肺动脉造影者均有PE诊断依据。误诊时间：2周12例，6周至2年11例。最多是误诊为心绞痛或心肌梗塞者，共19例（826%）结论：晕厥、突发性呼吸困难、下肢静脉血栓为疑诊肺栓塞的主要征象，核素肺扫描、肺动脉造影为其诊断主要手段。 【关键词】 肺栓塞 老年人 误诊 Analysis of misdiagnosis of pulmonary embolism in aged patients with pulmonary and cardiovascular diseases(retrospective study of 23 cases with pulmonary embolism)/SONG Cheng|yun, HUANG Ping, TANG Zhi|quan, WANG Qing|sheng, ZHAO Ting, ZHANG Zhen|hua, CUI Lian, ZHAO Jin|cai, HAN Ying//Chinese Journal of Cardiovascular Rehabilitation Medicine,2007，16（3）：282 Abstract：Objective:Analysis of misdiagnosis of pulmonary embolism(PE) in aged patients with pulmonary and cardiovascular diseases.Methods:The data of 23 cases of pulmonary embolism were retrospective study according diagnosis.Results:There was respiratory dyspnea burst in 78% patients.There were 5 patients(217%) with syncope appeared first.All patients(100%) had hypoxxemia.The 8 patients had embolism of low extremity vein in 10 patients performed phlebography of low extremity.All patients(100%) had diagnosis sign of PE in 14 patients performed nuclide lung scan and 18 patients preformed pulmonary arteriography.Time of misdiagnosis was 2 weeks in 12 cases,and 6 weeks to 2 years in 11 cases.The PE patients misdiagnosed to angina or myocardial infarction were most(19 cases,826%).Conclusion:Syncope,respiratory dyspnea burst and embolism of low extremity vein are chief sign of suspect pulmonary embolism,its main diagnosis methods are nuclide lung scan and pulmonary arteriography. Author′s　address：The 305 hospital of PLA， Beijing，100017, China Key words：Pulmonary embolism；The aged；Misdiagnosis 肺动脉血栓栓塞(pulmonary thromboembolism，PTE；简称肺栓塞，PE）即血栓堵塞肺动脉或其分支引起肺循环障碍的临床和病理生理综合征。由于PE缺乏特异性症状和体征，其误诊率、漏诊率很高[1]。西方国家PE病人生前未确诊者高达67%～79%[2]。近年来，PE的研究取得了很大进展，但老年人常患有心肺基础疾病，使其诊断和治疗仍具难度[2]，本文报告23例老年人PE的误诊情况，旨在减少临床误诊、漏诊。 1 资料与方法