46例老年肺心病病理与临床对比分析

目的总结临床诊断老年肺心病的成功经验与失败教训。方法对４６例老年肺心病病例以病理解剖与临床资料对照的方法，从发病年龄、临床误诊率、临床漏诊率、病因、死亡原因、右室壁平均厚度与病程和死亡年龄的关系以及肺心病伴发冠心病等方面进行分析。结果本组老年肺心病平均发病年龄为６５岁。肺心病临床总误诊率达２７％，总漏诊率６％。肺心病病因以慢性支气管炎、肺气肿最常见占８４％。其死亡原因以呼吸衰竭和全心衰竭为主占５３％。平均右室壁厚度随肺心病病程和死亡年龄升高而增加。肺心病伴发冠心病者占４１％。结论以上结果表明老年肺心病临床误诊率较高，应严格掌握肺心病诊断标准以降低临床误诊率。积极降低慢性支气管炎和肺气肿的发病率仍是预防肺心病的重要环节。老年肺心病伴发冠心病的比率较高应引起重视。努力防治呼吸衰竭和心力衰竭能够有效的降低老年肺心病的死亡率。

A clinicopathological analysis in 46 elderly cases with cor pulmonale

OBJECTIVE: To recognize the successful experience in diagnosis of cor pulmonale. METHOD: Autopsy records of 46 elderly patients with cor pulmonale were retrospectively analyzed. RESULTS: The average age of cor pulmonale in aged patients is 65. Most patients were died in the age of 70-79. The rates of incorrect diagnosis and mis diagnoss of cor pulmonale in elderly patients were 27% and 6% respectively. Chronic bronchitis and chronic obstructive emphysema were the most commen causes of cor pulmonale in elderly patients with a rate of 84%. The main cause of death were respiratory failure and heart failure with a rate of 53%. The average thickness of right ventricle wall increased with the course of cor pulmonale and the age of death. About 41% cor pumonale cases were combined with coronary heart disease. CONCLUSIONS: These results indicated that the rate of incorrect diagnoses of cor pulmonale in elderly patients was high, and great effort should be made to draw the clinician's attention for diagnose this illness correctly. The best way to reduce the incidence of cor pulmonale is to prevent and treat chronic bronchitis and chronic obstructive emphysema. Prevent and treat respiratory failure and heart failure effectively may decrease the mortality of cor pulmonale in elderly patients.