肺栓塞患者178例临床特征及误诊分析

［摘要］目的　分析肺栓塞患者的临床资料，总结肺栓塞的临床特征，以提高诊断率，改善预后．方法　回顾性分析2011年1月至2014年12月在昆明医科大学第二附属医院住院治疗并确诊为肺栓塞的178例患者的临床资料，对相关危险因素、临床表现、客观检查资料、误诊以及预后等情况等进行分析．结果　患者有明显的肺栓塞相关基础疾病和危险因素，患者的临床症状、体征和心电图、血气分析等常规检测显示患者存在缺氧和心血管损伤，但是缺乏特异性；患者的初诊误诊率为48.88%，误诊为COPD 22例、肺炎18例和冠心病16例，老年患者误诊率为56.36%，中青年患者误诊率为36.80%，差异有统计学意义（P＜0.05）；CTPA可以准确的观察肺动脉栓塞后出现的肺血管充盈缺损，进而确诊肺栓塞，本组病例均通过CTPA而确诊；老年患者院内死亡11人，病死率10%，中青年患者院内死亡2人，病死率为2.9%，差异无统计学意义（P＞0.05）．结论　尽管患者肺栓塞相关的危险因素较多，但基础疾病多且复杂，症状、体征和常规检查的特异性较差，首诊误诊率高，患者预后差；CTPA检查对于诊断肺栓塞可靠，临床上应加强对存在肺栓塞风险患者的CTPA的检查，提高患者的诊断率，改善预后．

Analysis of Clinical Characteristics and Misdiagnosis of 178 Patients with Pulmonary Embolism

［Abstract］Objective The study aimed to analyze the clinical data of patients with pulmonary embolism and summarize the clinical characteristics of pulmonary embolism， in order to improve the correct diagnostic rate and the prognosis. Methods Data of 178 patients who were cured in our hospital from January 2011 to December 2014 were analyzed retrospectively， including relative risk factors，clinical behaviors，examination data， misdiagnosis and prognosis. Results Patients with pulmonary embolism had related basic diseases and risk factors. Their clinical symptoms， signs and ordinary detection methods indicated pneumatorexis and cardiovascular injury， but lacked of specificity. The misdiagnosis rate of the first diagnosis was 48.88%，including 22 cases of the misdiagnosis to COPD，18 cases to pneumonia and 16 cases to coronary heart disease. The misdiagnosis rate of elderly patients was 56.36%， while that of the young and middle-aged patients was 36.80%，the difference was statistically significant，P < 0.05. Computed tomography pulmonary angiography（CTPA）could accurately observe the pathological changes of pulmonary embolism，and all the patients were diagnosed by CTPA in the research. 11 cases（10%）of elderly patients died，while 2 cases（2.9%）happened in young and middle-aged patients. There was no statistical significant difference（P > 0.05）. Conclusion Although the related risk factors of pulmonary embolism in patients existed，the misdiagnosed rate of the disease was high and prognosis was poor due to many confusing basic diseases. And the symptoms，signs and ordinary inspection of the patients lacked specificity. CTPA，being utilized to diagnose pulmonary embolism reliably，should be promoted.