呼吸科住院患者肺血栓栓塞症延迟诊断的危险因素分析  

Risk factors of diagnostic delay of pulmonary thromboembolism in hospitalized patients at department of respiratory medicine

作　　者：李然[1] 刘晓芳[1] 盛海燕[1] 白澎[1] LI Ran;LIU Xiaofang;SHENG Haiyan;BAI Peng(Department of Respiratory Medicine,Beijing Tongren Hospital,Capital Medical University,Beijing 100730,China)

机构地区：[1]首都医科大学附属北京同仁医院呼吸与危重症医学科,北京100730

出　　处：《中国医药导报》2021年第16期91-94,共4页China Medical Herald

摘　　要：目的探讨呼吸科住院患者肺血栓栓塞症(PTE)诊断延迟的危险因素。方法收集2011年12月—2019年12月北京同仁医院呼吸科初次诊为PTE的98例住院患者的临床资料,依据PTE确诊的中位时间分为延迟诊断组(39例)和非延迟诊断组(59例)。分析两组间临床资料差异,应用logistic回归分析PTE诊断延迟的危险因素。结果延迟诊断组合并基础肺疾病、慢性阻塞性肺疾病(COPD)及哮喘的比例高于非延迟诊断组,差异均有统计学意义(均P<0.05)。近1个月有手术史的比例低于非延迟诊断组,差异有统计学意义(P<0.05)。延迟诊断组咯血、晕厥、下肢水肿的发生率,D-二聚体数值,简化Wells评分和修订版Geneva评分低于非延迟诊断组,差异均有统计学意义(均P<0.05);呼吸困难、发热的发生率高于非延迟诊断组,差异均有统计学意义(均P<0.05)。合并肺部基础病(OR=13.566,95%CI:2.410,76.373)及COPD(OR=7.030,95%CI:1.265,39.065)是PTE诊断延迟的危险因素(P<0.05)。结论呼吸科住院患者存在较高的PTE延迟诊断发生率,合并COPD是导致PTE诊断延迟的独立危险因素,应重视COPD合并PTE的诊断。Objective To explore the risk factors of diagnostic delay of pulmonary thromboembolism(PTE)in hospitalized patients at department of respiratory medicine.Methods Clinical data of 98 inpatients with PTE initially diagnosed in the Department of Respiratory Medicine,Beijing Tongren Hospital from December 2011 to December 2019 were collected,and they were divided into delayed diagnosis group(39 cases)and non-delayed diagnosis group(59 cases)according to the median time of PTE diagnosis.The difference of clinical data between the two groups was analyzed,and the risk factors of delayed PTE diagnosis were analyzed by logistic regression.Results The rates of basic pulmonary disease,chronic obstructive pulmonary disease(COPD)and asthma in the delayed diagnosis group were higher than those in the non-delayed diagnosis group,and the differences were all statistically significant(all P<0.05).The proportion of patients with surgical history in the last one month was lower than that in the non-delayed diagnosis group,and the difference was statistically significant(P<0.05).The incidence of hemoptysis,syncopal and lower limb edema,D-dimer value,simplified wells score and revised Geneva score in the delayed diagnosis group were lower than those in the non-delayed diagnosis group,with statistical significance(all P<0.05).The incidence of dyspnea and fever were higher than that in the non-delayed diagnosis group,and the differences were all statistically significant(all P<0.05).Pulmonary underlying disease(OR=13.566,95%CI:2.410,76.373)and COPD(OR=7.030,95%CI:1.265,39.065)were risk factors for delayed diagnosis of PTE(P<0.05).Conclusion There is a high prevalence in diagnostic delay of PTE in hospitalized patients at department of respiratory medicine.COPD is independently and significantly related to the diagnostic delay of PTE.

关 键 词：呼吸内科 肺血栓栓塞症 延迟诊断 危险因素 

分 类 号：R563[医药卫生—呼吸系统]