肺栓塞36例急诊误诊临床分析  

Clinical Analysis of 36 Cases of Misdiagnosed Pulmonary Embolism in Emergency Department

作　　者：尹红军[1] 蒋志锋[1] 李树[1] 金爱春[1] 刘福军[1] 

机构地区：[1]首都医科大学潞河教学医院急诊科,北京101149

出　　处：《临床误诊误治》2012年第7期1-3,共3页Clinical Misdiagnosis & Mistherapy

摘　　要：目的提高急诊科医生对肺血栓栓塞(pulmonary thromboembolism,PTE)的认识,探索急诊可行的PTE诊断程序,以提高本病早期确诊率。方法回顾性分析近5年来我院急诊误诊的36例PTE的临床资料,并进行改良Geneva评分评估临床诊断可能性。结果本组36例误诊为心血管疾病25例(69.4%),误诊为其他呼吸系统疾病9例(25%),误诊为脑血管疾病2例(5.6%),其中30例(83.3%)有易患因素。进行改良Geneva评分显示PTE中度可能性26例,低度可能性10例。查D-二聚体36例均升高,后经螺旋CT肺动脉造影(CTPA)确诊32例、肺通气灌注扫描确诊4例,均予抗凝治疗好转出院。结论 PTE临床易误漏诊,急诊科医生应加强对本病的认识,接诊PTE疑诊患者应询问有无易患因素,通过改良Geneva评分进行诊断可能性评估,结合血D-二聚体检测,必要时可行CTPA等,以提高确诊率。Objective To improve the diagnostic recognition and the rate of early definite diagnosis of pulmonary embolism （PE）, and explore diagnostic program of PE in emergency departnmnt. Methods Clinical data of 36 cases with misdiagnosed PE in emergency department were reviewed and the revised Geneva score was compared. Results 25 cases were misdiagnosis as cardiovascular disease （69.4%）, 9 cases regarded as other respiratory disease （25%） and 2 cases as cerebrum dise,ase （5.6%）. There were 30 patients （83.3%） with risk factors. The revised Geneva scores were obtained, 26 cases with intermediate probability clini- cal assessment and 10 cases with low probability. There were high D-dimer concentration in 36 cases. 32 cases were diagnosed as pulmonary embolism by spiral CT pulmonary angiography （CTPA） and 4 cases by Lung ventilation/pedhsion scan. Conclusion Misdi- agnosis and underdiagnosis are usually due to PE, It is nessesary to improve the knowledge of PE for doctors in En：Lergency department. To improve the rate of early definite diagnosis of PE and tile risk [actors of PE is necessary, the revised Geneva scores are used to assess clinical probability and the D-dimer concentration should be taken into account for patients with suspected PE. CTPA is optional.

关 键 词：急诊科 肺栓塞 误诊 冠状动脉疾病 肺疾病 慢性阻塞性 

分 类 号：R563.5[医药卫生—呼吸系统]