肺栓塞误诊为心内科疾病的原因探究

目的探讨肺栓塞误诊为心内科疾病的原因。方法回顾性分析误诊为心内科疾病的23例肺栓塞的临床资料,并复习相关文献。结果本组胸闷、气短15例,其中伴咯血3例;8例以晕阙为主。查体发现口唇发绀20例,左侧胸骨旁2~4肋间可闻及收缩期杂音14例,颈静脉怒张9例,双肺底可闻及湿啰音13例,呼吸急促18例,心动过速15例,肺动脉瓣区第二心音亢进12例。23例均在入院时误诊为心内科疾病,其中13例误诊为不稳定型心绞痛,10例误诊为非ST段抬高型心肌梗死。误诊时间8~72(42.52±5.14)min。23例初步诊断后均予对症处理,但症状均无改善,后进一步完善冠状动脉造影、双源CT冠状动脉血管成像或肺血管重建CT检查,确诊为肺栓塞,其中21例予尿激酶溶栓、低分子肝素抗凝治疗,辅以华法林及常规内科综合治疗,症状好转出院;2例病情恶化死亡。结论接诊医师未认真鉴别诊断、缺乏警惕性、未运用综合诊断思维、无特异性临床表现等是肺栓塞误诊为心内科疾病的原因,值得临床关注。

Misdiagnosis Causes of Pulmonary Embolism as Cardiovascular Disease

Objective To explore the causes of misdiagnosis of pulmonary embolism(PE)as cardiovascular disease.Methods Clinical data of 23 patients with PE misdiagnosed as cadiovascular disease in our hospital were analyzed retrospectively,and related literature was reviewed.Results In this group,chest tightness and shortness of breath were found in 15 patients,including 3 patients accompanied with hemoptysis.Another 8 patients mainly had syncope.Physical examination revealed cyanosis of the lips in 20 patients,systolic murmurs on left sternal border(between 2nd to 4th ribs)of 14 patients,distention of jugular vein in 9 patients,moist rale in basal lungs of 13 patients,shortness of breath in 18 patients,tachycardia in 15 cases and accentuation of second cardiac sound in the pulmonary valve area of 12 patients.And 23 patients were misdiagnosed as cardiovascular diseases when admitted to hospital,of whom 13 were misdiagnosed as unstable angina pectoris,and the other 10 as non-ST segment elevation myocardial infarction.The duration of misdiagnosis was 8-72(42.52±5.14)min.All 23 patients was given symptomatic treatment after initial diagnosis,but no symptom was improved.After coronary angiography,dual-source CT coronary angiography or pulmonary vascular reconstruction CT examination,pulmonary embolism was confirmed,and 21 patients were treated with urokinase thrombolysis and low-molecular-weight heparin,supplemented with warfarin and conventional medical treatment.They were discharged from hospital after the symptoms were improved.Two patients had deteriorated condition and died.Conclusion The inadequate differential diagnosis,lack of vigilance,diagnosis without comprehensive thinking,and non-specific clinical manifestations are the causes of misdiagnosis of PE as cardiovascular disease,which deserves clinical attention.