中国全科医学2018，Vol.21Issue(7)：804-808,5.DOI:10.3969/j.issn.1007-9572.2018.07.010
老年肺栓塞早期诊断延误的影响因素研究
Associated Factors of Diagnostic Delay of Pulmonary Embolism at an Early Stage among Elderly Patients
摘要
Abstract
Objective To investigate the associated factors of diagnostic delay of pulmonary embolism (PE) at an early stage among elderly patients. Methods The enrolled participants were 130 elderly patients with a final diagnosis of PE treated in Fuyang People's Hospital between January 2012 and July 2016. Of them, 68 timely underwent related examinations due to a initial diagnosis of suspected PE were assigned to the early diagnosis group, and other 62 did not due to a initial diagnosis of non-suspected PE were assigned to the early delay group. We compared their baseline and laboratory characteristics. The associated factors of diagnostic delay of PE at an early stage were analyzed using multivariate logistic regression. Results The rate of diagnostic delay of PE at an early stage among these elderly patients was 47.7% (62/130). Compared with those diagnosed at an early stage, patients with delayed diagnosis were older, and higher proportion of them were found with chest pain as the initial symptom, with coronary heart disease, chronic bronchitis or cardiac dysfunction, but lower proportion of them were identified with syncope, or edema of lower extremities as the initial symptom, and they were less likely to have risk factors such as a history of recent surgery/fracture, deep venous thrombosis, and long-term bedridden conditions (P<0.05). The distribution of gender, proportion of patients with chest tightness, asthma, cough and fever as the initial symptom, signs (body temperature, pulse, respiratory rate, systolic blood pressure, diastolic blood pressure), prevalence of hypertension, cerebral infarction, diabetes, and percentage of patients with the risk factor of tumor/ space-occupying lesion did not differ significantly between the two groups (P>0.05). Patients with delayed diagnosis demonstrated higher prevalence of ST-T wave abnormalities on an ECG, longer duration between timing of initial diagnosis and CTPA results reporting time, longer duration between timing of initial diagnosis and D-dimer test results reporting time, higher prevalence of S1Q3T3 pattern on an ECG, as well as higher prevalence of echocardiographic abnormalities compared with those with diagnosis at an early stage (P<0.05). Two groups showed no significant differences in the distribution of PE locations identified by CTPA (right pulmonary artery, left pulmonary artery, bilateral pulmonary arteries), levels of D-dimer, C-reactive protein and B-type natriuretic peptide, analysis results of arterial blood gas test (levels of pH, partial pressure of oxygen and partial pressure of carbon dioxide), levels of Troponin I, homocysteine, total cholesterol and low-density lipoprotein cholesterol (P>0.05). Multivariate Logistic regression analysis results indicated that age, cardiac insufficiency, coronary heart disease, chronic bronchitis, duration between timing of initial diagnosis and CTPA results reporting time , and duration between timing of initial diagnosis and D-dimer test results reporting time were the associated factors for diagnostic delay of PE at an early stage among elderly patients (P<0.05). Conclusion The rate of diagnostic delay of PE at an early stage among elderly patients was high. Older age, prevalence of cardiac insufficiency, coronary heart disease or chronic bronchitis, prolonged duration between timing of initial diagnosis and CTPA results reporting time, prolonged duration between timing of initial diagnosis and D-dimer test results reporting time were the risk factors for diagnostic delay of PE at an early stage among this population, which should be paid attention, and should be identified as early as possible.关键词
肺栓塞/延迟诊断/老年人/影响因素分析/CT肺血管造影/D-二聚体Key words
Pulmonary embolism/Delayed diagnosis/Aged/Root cause analysis/CT pulmonary angiography/D-dimer分类
医药卫生引用本文复制引用
徐琪,周瑞清,王红旗,孙良,万俊峰..老年肺栓塞早期诊断延误的影响因素研究[J].中国全科医学,2018,21(7):804-808,5.基金项目
安徽省卫生与计划生育委员会第二批科研计划项目(13FR013) （13FR013）
