摘要
目的提高对肺栓塞(pulmonary embolism,PE)各种临床表现的认识,减少误漏诊的发生。方法回顾分析清华大学附属第一医院2009年1月—2017年3月就诊的入院时未能确诊的87例PE患者资料,根据入院时诊断分为初诊组56例和误漏诊组31例,比较两组临床特点,分析误漏诊组误漏诊疾病、科室和原因。结果两组均无典型PE"三联征"表现,主要表现为呼吸困难、胸闷,误漏诊组胸痛比例更高,呼吸困难、下肢水肿比例更低;误漏诊组中96.8%的患者存在PE风险因素,但入院前几未行血气分析及D-二聚体检测。误漏诊组中,误诊为心绞痛18例(58.1%),余分别误诊为心功能不全、脑梗死、心房颤动、肺部感染、喘息性支气管炎、反流性食管炎等。误漏诊发生在心内科23例(74.2%),中位漏误诊时间为4 d。87例均在入院后完善D-二聚体检查及血气分析提示PE,进一步行CT肺动脉造影等检查确诊。结论 PE临床表现缺乏特异性,缺乏血气分析及D-二聚体检测的支持和固守局部的思维模式是导致误漏诊的主要原因。提高对PE的认识,建立发散性的思维模式,并尽早行血气分析及D-二聚体检测可减少临床误漏诊。
Objective To improve awareness of clinical features of pulmonary embolism （ PE） in order to reduce in-cidence rates of misdiagnosis and missed diagnosis. Methods Case data of 87 PE patients during January 2009 to March 2017, who could not be confirmed at the time of admission, was retrospectively analyzed, and the patients were divided into suspect group （n=56） and misdiagnosis and missed diagnosis group （n=31） according to the diagnosis at admission. Clini-cal features were compared in two groups. Misdiagnosed and missed diseases, departments and causes of misdiagnosis and missed diagnosis were analyzed in misdiagnosis and missed diagnosis group. Results All patients had no typical PE triad signs, and the main clinical manifestations were dyspnea and chest distress;in misdiagnosis and missed diagnosis group, pro-portion of having chest pain was higher, while proportions of having dyspnea and edema of lower extremity （n=66） were low-er. In misdiagnosis and missed diagnosis group, 96. 8% patients had PE risk factors, but few of them had blood gas analysis or D-Dimer examination before admission. In misdiagnosis and missed diagnosis group, 18 patients were misdiagnosed as hav-ing angina （58. 1%）, and the rest of them were misdiagnosed as having cardiac insufficiency, cerebral infarction, atrial fi-brillation, pulmonary infection, asthmatic bronchitis, reflux esophagitis and so on. A total of 23 patients （74. 2%） were mis-diagnosed or missed diagnosis by physicians of cardiovascular department, and median time of misdiagnosis and missed diagno-sis was 4 d. Blood gas analysis and D-Dimer examination were performed for the 87 patients after admission, and the results suggested PE, and then the PE was confirmed by further computed tomography pulmonary angiography （ CTPA） examination. Conclusion Misdiagnosed and missed diagnosed causes of pulmonary embolism are lack of specifically clinical manifesta-tions, supporting by results of blood gas analysis and D-Dimer examination and closed thinking, and misdiagnosis and missed diagnosis rates can be reduced by strengthening understanding of pulmonary embolism, establishing divergent thinking of diag-nosis and performing blood gas analysis and D-Dimer examination timely.
出处
《临床误诊误治》
2017年第10期35-40,共6页
Clinical Misdiagnosis & Mistherapy
基金
北京市科委科研计划(11720672)
关键词
肺栓塞
误诊
漏诊
心绞痛
血气分析
D-二聚体
Pulmonary embolism
Misdiagnosis
Missed diagnosis
Angina pectoris
Blood gas analysis
D-Dimer
