88岁以上急性肺动脉血栓栓塞症患者误诊分析及文献复习  

Analysis of Misdiagnosis of Acute Pulmonary Thromboembolism in Patients Aged over 88 Years and Literature Review

作　　者：杨栋才 任慧敏 程家欣 路晨阳 卜丽娜 刘志燕 李楠[1] 贾卫红 YANG Dongcai;REN Huimin;CHENG Jiaxin;LU Chenyang;BU Lina;LIU Zhiyan;Li Nan;JIA Weihong(Department of Respiratory and Critical Care Medicine,the Third Hospital of Xi'an City,the Affiliated Hospital of Northwest University,Xi'an 710083,China)

机构地区：[1]西北大学附属医院西安市第三医院呼吸与危重症医学科,西安710083

出　　处：《临床误诊误治》2023年第8期1-7,共7页Clinical Misdiagnosis & Mistherapy

基　　金：西安市科技局项目[2017113SF/YX007(2)];西安市卫健委项目(2021lyb41);西安市卫健委项目(2021lyb42)。

摘　　要：目的 探讨88岁以上急性肺动脉血栓栓塞症(APTE)患者的临床特点及误诊原因、防范措施。方法 对2020年1月—2023年5月收治的88岁以上APTE 4例的临床资料进行回顾性分析。结果 本组4例均有冠心病,有高血压病3例,糖尿病和心房颤动各2例,慢性阻塞性肺疾病1例。出现胸闷、气短和咳嗽、咳痰各4例,胸痛、晕厥和发热各1例。轻度低氧血症1例,中度低氧血症3例,Ⅰ型呼吸衰竭3例。心电图检查心房颤动、ST-T改变和T波倒置各2例,一度房室传导阻滞1例。肺动脉CT血管造影(CTA)检查均提示双侧多发肺栓塞。曾误诊为肺炎2例,冠心病1例,呼吸衰竭1例。误诊时间2~15 d。4例均经肺动脉CTA检查确诊,均给予抗凝治疗7~10 d好转出院。3例出院后随访3个月治愈,1例正在随访中。结论 88岁以上APTE患者误诊主要原因为基础疾病多、心肺功能差,掩盖了急性肺栓塞引发的临床症状。临床上对于有手术、创伤、恶性肿瘤及心、肺、脑慢性疾病的88岁以上患者应常规进行深静脉栓塞筛查,必要时进行肺栓塞排查。Objective To investigate the clinical characteristics,causes of misdiagnosis and preventive measures of acute pulmonary thromboembolism(APTE)in patients aged over 88 years.Methods The clinical data of 4 patients aged over 88 years who had APTE and was admitted from January 2020 to May 2023 were retrospectively analyzed.Results There were 4 cases of coronary heart disease(CHD),3 cases of hypertension,2 cases of diabetes,2 cases of atrial fibrillation,and 1 case of chronic obstructive pulmonary disease(COPD).Chest tightness,shortness of breath,cough and expectoration occurred in 4 cases,respectively,chest pain in 1 case,syncope in 1 case and fever in 1 case.There was 1 cases of mild hypoxemia,3 cases of moderate hypoxemia and 3 cases of type I respiratory failure.ECG examination of atrial fibrillation,ST-T changes and T wave inversion in 2 cases,respectively,and 1 case of first degree atrioventricular block(AVB).CT angiography(CTA)of pulmonary artery indicated multiple pulmonary embolism.It was misdiagnosed as pneumonia in 2 cases,CHD in 1 case and respiratory failure in 1 case.Misdiagnosis lasted from 2 to 15 d.After confirmation by pulmonary CTA,all patients were treated with anticoagulant therapy for 7-10 d and discharged from hospital.At 3 months after discharge,3 cases were cured and 1 case was under follow-up.Conclusion The main causes of misdiagnosis of APTE patients aged over 88 years were many underlying diseases and poor cardiopulmonary function,which masked the clinical symptoms caused by acute pulmonary embolism.In clinical practice,patients aged over 88 years with surgery,trauma,malignant tumors and chronic diseases of the heart,lung and brain should be routinely screened for deep vein embolism,and pulmonary embolism screening should be performed if necessary.

关 键 词：肺栓塞 老年人 88岁以上 误诊 肺炎 冠心病 呼吸功能不全 血管造影术 体层摄影术 螺旋计算机 

分 类 号：R563.5[医药卫生—呼吸系统]