住院患者慢性阻塞性肺疾病相关误诊原因分析及对策  

Analysis of Misdiagnosis Causes of Chronic Obstructive Pulmonary Disease and Its strategies during Hospitalization

作　　者：吴晓驰 周恩飞 罗勇[1,3] 章敬玉[1] 陆惠昌 

机构地区：[1]交通大学医学院附属新华医院崇明分院呼吸科,上海202150 [2]上海市崇明堡镇人民医院呼吸科,上海202157 [3]交通大学医学院附属新华医院呼吸科,上海200092

出　　处：《临床误诊误治》2011年第11期7-9,共3页Clinical Misdiagnosis & Mistherapy

基　　金：上海市慢性病综合防治项目(SHDC12007301);上海交通大学医学院科技基金项目(09XJ22007)

摘　　要：目的探讨住院患者慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)相关误诊原因及对策。方法回顾性总结分析2010年1月～2011年6月收治且出、入院诊断与COPD相关的1047例的临床资料。结果 1047例中983例出、入院诊断均为COPD急性发作(AECOPD),64例出、入院诊断不符,误漏诊率6.1%。入院时诊断AECOPD,出院时诊断其他疾病45例,出院诊断分别为慢性支气管炎10例,气胸7例,支气管扩张及冠心病左心功能不全各6例,支气管哮喘4例,肺结核3例,特发性肺纤维化、冠心病急性心肌梗死、脑梗死各2例,肺栓塞、低血糖、弥漫性泛细支气管炎各1例。入院时未诊断COPD而出院时诊断COPD 19例,入院时误诊为冠心病左心功能不全12例,支气管哮喘及急性脑梗死各3例,肺炎1例。结论 COPD虽为常见疾病,但误漏诊率仍偏高,认真询问病史、细致查体以及全面综合分析各种医技检查和肺功能检查资料,有助于对疾病做出正确的诊断。Objective To explore the relevant misdiagnosis causes and strategies of chronic obstructive pulmonary disease（COPD） during hospitalization.Methods We retrospectively analyzed 1047 inpatients whose admitted diagnosis and discharged diagnoss had correlation with COPD during January 2010 and June 2011.Results The admitted diagnosis（acute exacerbation of COPD） were identical with discharge in 983 cases from 1047,while there was a 6.1% misdiagnosis rate in 64 cases whose admitted diagnosis were different from that of discharge.45 cases were diagnosed as COPD on admisson,but were diagnosed as others disease on discharge form hospital.Ten cases with chronic bronchitis,7 cases with pneumothorax,6 cases with bronchiectasis,6 cases with coronary disease accompanied by left heart failure,4 cases with bronchial asthma,3 cases with tuberculosis,2 cases with idiopathic pulmonary fibrosis,2 cases with acute myocardial infarction,2 cases with cerebral infarction,1 case with pulmonary embolism,1 case with hypoglycemia and 1 case with diffuse panbronchiolitis were misdiagnosed as COPD on admission.But there were 19 cases who were not diagnosed as having COPD upon admission but were definitely diagnosed as having COPD upon discharge.12 cases with left heart insufficiency of coronary heart disease,3 cases with bronchial asthama,3 cases with acute infarction of the brain,1 case with pneumonia were misdiagnozed on admission.Conclusion The misdiagnosis rate of COPD is still relatively high,although it is a common disease.Earnest history inquiry,careful physical examination and comprehensive analysis of patients＇ data are helpful in avoiding misdiagnosis of COPD.

关 键 词：肺疾病 慢性阻塞性 误诊 支气管炎 气胸 支气管扩张 冠心病 

分 类 号：R563.9[医药卫生—呼吸系统]