急诊中对肺血栓栓塞症的诊断及误诊病例分析

目的　探讨急诊肺血栓栓塞症 ( PTE)的鉴别诊断问题 ,以提高 PTE的正确诊断率。方法　对安贞医院心肺血管医疗抢救中心 2 0 0 0年 1月— 2 0 0 3年 8月底收治的 PTE病例进行分析。对将 PTE诊断为肺炎、心脏病、脑供血不足的病例和其他疾病误诊为 PTE的病例进行举例分析。结果　外院将 PTE误诊为细菌性肺炎者 5例 ,心脏病 7例 ,脑供血不足或神经系统疾患 3例。肺或纵隔肿瘤被疑似为 PTE4例 ,细菌性肺炎疑似为 PTE2例 ,支气管扩张症被误诊为 PTE1例。结论　 PTE的鉴别诊断至关重要 ,应引起高度重视 ,特别是急诊一线的医务人员更应掌握 PTE的基本诊断方法 ,减少误诊和漏诊

Analysis of diagnosis and misdiagnosis of pulmonary thromboembolism in emergency

Objective To investigate the differential diagnosis of pulmonary thromboembolism in emergency in order to increase the correct diagnosis rate of pulmonary thromboembolism. Methods The data of patients who were diagnosed pulmonary thromboembolism in Emergency Intensive Care Center of Anzhen Hospital from January 2000 to the end of August 2003 were analyzed. Patients were divided into two groups. One group of patients with pulmonary thromboembolism were diagnosed pneumonia, heart disease and cerebrovascular disease. The other group of patients were not pulmonary thromboembolism and were misdiagnosed. Results Five patients with pulmonary thromboembolism were diagnosed pneumonia, 7 and 3 patients were diagnosed heart disease and cerebrovascular disease, respectively. In the other group, 4 patients with lung or mediastinal tumors, 2 with pneumonia and 1 with bronchiectasis were diagnosed pulmonary thromboembolism. Conclusion It is essential to correctly diagnose pulmonary thromboembolism , especially emergency physicians should master diagnosis method of pulmonary thromboembolism and reduce the rate missed of diagnosis.