老年肺栓塞的临床特征及其漏、误诊原因分析  

作　　者：沈维敏[1] 李向阳[1] 龚瑾[1] 盛华[1] 梁红[1] 

机构地区：[1]上海市华东医院呼吸科,200040

出　　处：《临床肺科杂志》2008年第3期272-273,共2页Journal of Clinical Pulmonary Medicine

摘　　要：目的探讨老年肺栓塞临床误、漏诊的原因及其预防措施。方法研究25例经CTA或MRA证实的肺栓塞,平均年龄为67.5岁,比较临床表现、放射学表现、病史及其合并的疾病。结果25例中呼吸困难(18例),晕厥(10例)、咯血(7例)、胸痛(6例)。有11例误诊,其中误诊为肺炎3例,肺不张2例,心肌梗死2例,急性左心衰1例,3例为漏诊。误诊原因临床表现和放射学表现的复杂多样;医生诊断水平不高、认识不足造成漏诊。控制相关危险因素是预防老年肺栓塞的有效方法。结论老年肺栓塞误诊原因主要是老年患者心肺合并疾病的症状掩盖了肺栓塞症状,对有手术、外伤、肿瘤和心脑血管疾病的老年患者应行肺栓塞排查。Objective To explore the causes of misdiagnosis and missed diagnosis on the old patients with pulmonary embolism （PE） and the methods of their prevention. Materials 25 PE patients which the average age was 67.5 years old confirmed by CTA or MRA had been studied. To compare the history , complications, clinical and Radiology features both in correct diagnosis cases and misdiagnosis cases. Results 18 of 25 cases appeared dyspnea. 10 cases were qualm ;7 patients had emptysis and 6 patients occurred chest pain. 11 of 25 cases were been misdiagnosis. Among them, 3.cases were been misdiagnosis for pneumonia,2 cases regarded as pulmonary atelectasis. 2 cases as myocardical infarction and 1 case as acute left heart failure. 3 of 25 patients were been missed diagnosis as normal findings. The cause of misdiagnosis of PE is non-special features been found both in Radiology films and clinical symptoms in the old patients with PE. The skills of diagnosis was less developed both in radiologist and clinical physician were the important causes. The way of preventing the old patients from PE is controlling the related risk factors which may give rise to this diseases. Conclusion The misdiagnosis and missed diagnosis causes of PE in the senile patients were mainly because of doctor＇s little knowledge and limited conditions of medical equipment. Old patients after operation and trauma, Patients with tumor, cerebral-vascular diseases as well as cardiovascular diseases should be checked in time in order to exclude pulmonary embolism.

关 键 词：肺栓塞 误诊 漏诊 

分 类 号：R563.5[医药卫生—呼吸系统]