临床误诊误治2017，Vol.30Issue(10)：35-40,6.DOI:10.3969/j.issn.1002-3429.2017.10.013
急诊肺栓塞初诊与误漏诊病例的临床特点对比研究
Comparative Study of Clinical Features between Primary Diagnosed Cases and Misdiagnosed and Missed Diagnosis Cases of Pulmonary Embolism
摘要
Abstract
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.关键词
肺栓塞/误诊/漏诊/心绞痛/血气分析/D-二聚体Key words
Pulmonary embolism/Misdiagnosis/Missed diagnosis/Angina pectoris/Blood gas analysis/D-Dimer分类
医药卫生引用本文复制引用
方奕鹏,关键,陆艳辉,陈瑞,王志翊,王仲..急诊肺栓塞初诊与误漏诊病例的临床特点对比研究[J].临床误诊误治,2017,30(10):35-40,6.基金项目
北京市科委科研计划(11720672) （11720672）
