肺血栓栓塞症误诊为冠心病21例原因分析

目的探讨肺栓塞(pulmonary embolism,PE)误诊为冠心病的原因,并提出防范措施。方法对我院2005年7月—2013年7月收治的误诊为冠心病的肺血栓栓塞症(pulmonary thromboembolism,PTE)21例的临床资料进行回顾性分析。结果本组占同期收治PTE 25.3%。误诊为心绞痛11例、心肌梗死7例、缺血性心肌病3例。误诊时间3~15 h。按误诊疾病治疗无效或效果不佳,后结合临床表现,血浆D-二聚体测定、血气分析及螺旋CT肺动脉造影检查等综合分析后确诊PTE,予相应治疗,20例症状明显改善后出院,1例死亡,平均住院(32.1±9.6)d。结论提高对PE的认识、发散诊断思维、重视鉴别诊断及全面系统分析病情,可降低PE的早期误诊率。

Cause Analysis of Pulmonary Thromboembolism Misdiagnosed as Coronary Heart Disease in 21 Patients

Objective To explore the causes of pulmonary embolism（ PE）misdiagnosed as coronary heart disease （ CHD）in order to provide preventive measures. Methods Clinical data of 21 patients with pulmonary thromboembolism （ PTE）misdiagnosed as having CHD during July 2005 and July 2013 was retrospectively analyzed. Results The misdiagnosis cases accounted for 25. 3% PTE patients at the same period. The 11 patients were misdiagnosed as having angina pectoris,7 were misdiagnosed as having myocardial infarction,and 3 were misdiagnosed as having ischemic cardiomyopathy. The misdi-agnosis time was 3-15 h. The corresponding treatments were ineffective after treatment of misdiagnosed diseases,and PTE was confirmed after plasma D-Dimer test,blood gas analysis and spiral CT pulmonary arteriography combined with clinical manifes-tations. After corresponding treatment,20 patients were discharged after obvious symptom improvement,but 1 patient died, and the average hospital stay was（32. 1 ± 9. 6）d. Conclusion The PE misdiagnosis rate in early period may be reduced by improving awareness of PE,diagnosing with comprehensive thinking and paying attention to differential diagnosis and systemat-ic analysis.