临床误诊误治2023，Vol.36Issue(8)：1-7,7.DOI:10.3969/j.issn.1002-3429.2023.08.001
88岁以上急性肺动脉血栓栓塞症患者误诊分析及文献复习
Analysis of Misdiagnosis of Acute Pulmonary Thromboembolism in Patients Aged over 88 Years and Literature Review
摘要
Abstract
Objective To investigate the clinical characteristics,causes of misdiagnosis and preventive measures of acute pulmonary thromboembolism(APTE)in patients aged over 88 years.Methods The clinical data of 4 patients aged over 88 years who had APTE and was admitted from January 2020 to May 2023 were retrospectively analyzed.Results There were 4 cases of coronary heart disease(CHD),3 cases of hypertension,2 cases of diabetes,2 cases of atrial fibrillation,and 1 case of chronic obstructive pulmonary disease(COPD).Chest tightness,shortness of breath,cough and expectoration oc-curred in 4 cases,respectively,chest pain in 1 case,syncope in 1 case and fever in 1 case.There was 1 cases of mild hypox-emia,3 cases of moderate hypoxemia and 3 cases of type I respiratory failure.ECG examination of atrial fibrillation,ST-T changes and T wave inversion in 2 cases,respectively,and 1 case of first degree atrioventricular block(AVB).CT angiogra-phy(CTA)of pulmonary artery indicated multiple pulmonary embolism.It was misdiagnosed as pneumonia in 2 cases,CHD in 1 case and respiratory failure in 1 case.Misdiagnosis lasted from 2 to 15 d.After confirmation by pulmonary CTA,all pa-tients were treated with anticoagulant therapy for 7-10 d and discharged from hospital.At 3 months after discharge,3 cases were cured and 1 case was under follow-up.Conclusion The main causes of misdiagnosis of APTE patients aged over 88 years were many underlying diseases and poor cardiopulmonary function,which masked the clinical symptoms caused by acute pulmonary embolism.In clinical practice,patients aged over 88 years with surgery,trauma,malignant tumors and chronic diseases of the heart,lung and brain should be routinely screened for deep vein embolism,and pulmonary embolism screening should be performed if necessary.关键词
肺栓塞/老年人,88岁以上/误诊/肺炎/冠心病/呼吸功能不全/血管造影术/体层摄影术,螺旋计算机Key words
Pulmonary embolism/Aged,88 and over/Misdiagnosis/Pneumonia/Coronary heart disease/Respira-tory insufficiency/Angiography/Tomography,spiral computed分类
临床医学引用本文复制引用
杨栋才,任慧敏,程家欣,路晨阳,卜丽娜,刘志燕,李楠,贾卫红..88岁以上急性肺动脉血栓栓塞症患者误诊分析及文献复习[J].临床误诊误治,2023,36(8):1-7,7.基金项目
西安市科技局项目[2017113SF/YX007(2)] （2）
西安市卫健委项目(2021lyb41) （2021lyb41）
西安市卫健委项目(2021lyb42) （2021lyb42）
