以咳嗽为主要表现的老年早期不典型心力衰竭误诊分析  

Misdiagnosis of Early Atypical Heart Failure in Elderly Patients with Cough as the Main Manifestation

作　　者：熊鑫[1] 刘领[1] 薛兵[1] XIONG Xin;LIU Ling;XUE Bing(Department of Respiratory Medicine, Beijing Chuiyangliu Hospital, Beijing 100022, China)

机构地区：[1]北京市垂杨柳医院呼吸内科,北京100022

出　　处：《临床误诊误治》2019年第4期9-13,共5页Clinical Misdiagnosis & Mistherapy

摘　　要：目的提高临床医生对以咳嗽为主要表现的老年早期不典型心力衰竭(心衰)特点的认识,减少误诊误治。方法回顾性分析2015年6月—2018年6月我科收治的门、急诊及社区转诊的,以咳嗽为主要表现的老年早期心衰52例误诊病例资料。结果 52例均因咳嗽就诊,被误诊为肺炎18例、肺炎合并胸腔积液9例、支气管炎7例、低蛋白血症导致胸腔积液6例、咳嗽变异性哮喘5例、结核性胸膜炎4例、上呼吸道感染3例,误诊时间2 d～2年。入院后排除引起咳嗽的常见呼吸系统疾病后,依据"中国心力衰竭诊断和治疗指南2014"明确心衰诊断,给予强心、利尿、扩管及控制液体出入量等抗心衰治疗后,29例症状在3 d内明显好转或完全消失,15例症状3～7 d好转,8例症状7 d后好转,1例症状好转后新发急性脑梗死。结论老年早期心衰患者症状常不典型,咳嗽可能为唯一症状,尤其是夜间咳嗽,导致误诊率较高;临床医生应加强对心衰相关知识的学习,提高临床警惕性,避免误诊。Objective To improve clinicians' understanding of clinical characteristics of early atypical heart failure (HF) mainly manifested as cough in the elderly, and to reduce misdiagnosis and mistreatment. Methods Retrospective analysis was performed on 52 elderly patients with early atypical HF mainly manifested as cough and misdiagnosed from June 2015 to June 2018 after admission to our department for outpatient treatment, emergency treatment and community referral. Results Of the 52 cases who presented with cough,there was misdiagnosis as pneumonia in 18 cases, pneumonia with pleural effusion in 9 cases, bronchitis in 7 cases, pleural effusion caused by hypoalbuminemia in 6 cases, cough variant asthma in 5 cases, tuberculous pleurisy in 4 cases, and upper respiratory tract infection in 3 cases. The duration of misdiagnosis was 2 d-2 years. After excluding cough caused by common respiratory diseases at admission, diagnosis of HF was made according to the Guidelines for Diagnosis and Treatment of Heart Failure in China (2014). After anti-HF treatment, such as cardiotonic and diuretic treatment, tube expansion and control of fluid intake, symptoms of 29 cases were improved significantly or disappeared completely within 3 d, 14 cases had improved symptoms within 3-7 d, and 8 cases had improved symptoms after 7 d. In addition, 1 case had improved symptoms but developed acute cerebral infarction afterwards. Conclusion Symptoms of HF in early stage are often atypical in elderly patients, and cough may be the only symptom, especially nighttime cough, thereby leading to high misdiagnosis rate. Therefore, it is necessary for clinicians to accumulate HF-related knowledge and improve vigilance in clinical practice, in order to avoid misdiagnosis.

关 键 词：心力衰竭 老年人 咳嗽 误诊 肺炎 支气管炎 哮喘 

分 类 号：R541.6[医药卫生—心血管疾病]