肺栓塞诊断现况分析

目的了解肺栓塞诊断现况。 方法本院收治的67例肺栓塞患者，分为急性肺栓塞组(20例)，慢性肺栓塞组(47例)，回顾性分析入院前确诊率、确诊时间、确诊时是否出现持续性肺动脉高压以及常见误诊疾病。 结果①患者入院前确诊率23.9%，急性肺栓塞为55.0%，慢性肺栓塞为10.6%；肺栓塞合并下肢静脉血栓形成35.1%，单纯肺栓塞为6.7%。②慢性肺栓塞平均确诊时间为3.15年(最长为16年)，慢性肺栓塞组在确诊时78.3%患者已经形成中、重度持续性肺动脉高压；急性肺栓塞患者确诊时仅35.0%仍在有效溶栓时间窗内(≤2周)。③20.0%急性肺栓塞患者入院前诊断不明，20.0%误诊为急性心肌梗塞或心绞痛，5.0%误诊为慢性阻塞性肺部疾病急性发作期；44.7%慢性肺栓塞患者长期诊断不明，21.3%误诊为冠心病、心肌病或心力衰竭，17.0%误诊为原发性肺动脉高压，6.4%误诊为慢性阻塞性肺部疾病。 结论漏诊、误诊以致延误病情仍然是肺栓塞不容忽视的重要问题。

The Diagnosis of Pulmonary Embolism

Objective:To retrospectively analyze the current status of pulmonary embolis m diagnosis. 　　Methods:Patients with pulmonary embolism (PE) were admitted to our hospital. Data from the patients during hospitalization were collected and analyzed. 　　Results:①The confirmed diagnosis rate of PE before admission was 23.9% (16 /67),exactly,55.0% (11/20) in acute PE and 10.6% (5/47) in chronic PE.②The av erage time between the onset and the confirmed diagnosis of chronic PE was 3.15 years.When the diagnosis was confirmed,78.3% of the patients had developed per sistent pulmonary artery hypertension moderate or severe and only 35%of the pati ents with acute PE were still in the time-belt for thrombolytic therapy.③Befor e admission to our hospital,the diagnosis of acute PE was not definitive in 20. 0% (4/20),mistaken for acute myocardial infarction or angina pectoris in 20.0% (4/20) and for chronic obstructive pulmonary disease with acute onset in 5.0% ( 1/20).The diagnosis of chronic PE was not definitive in 44.7%(21/47) before adm ission,with 21.3% (10/47) misdiagnosed as coronary arterial disease,cardiomyopa thy or chronic heart failure,17.0% (8/47) as primary pulmonary hypertension,and 6.4% (3/47) as chronic obstructive pulmonary disease. 　　Conclusions:Although new diagnostic methods have been increasingly introduce d, the misdiagnosis rate of PE is still high.The diagnosis of pulmonary embolism re mains a problem.