慢性阻塞性肺疾病合并急性肺血栓栓塞症漏诊分析及文献复习  

Missed Diagnosis Analysis and Literature Review of Chronic Obstructive Pulmonary Disease Combined with Acute Pulmonary Thromboembolism

作　　者：贾卫红 霍雪清 艾娜娜 王媛媛[1] 张徽 JIA Weihong;HUO Xueqing;AI Nana;WANG Yuanyuan;ZHANG Hui(Department of Respiratory and Critical Care Medicine,the Third Hospital of Xi'an City,the Affiliated Hospital of Northwest University,Xi'an 710083,China;Department of Anesthesiology,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 [2]西北大学附属医院西安市第三医院麻醉科,西安710083

出　　处：《临床误诊误治》2024年第2期18-24,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：目的分析慢性阻塞性肺疾病(COPD)合并急性肺血栓栓塞症临床特点和漏诊原因、防范措施。方法回顾性分析2019年1月—2023年10月收治的COPD合并急性肺血栓栓塞症6例的临床资料。结果6例均因长期咳嗽、气短等且近期加重入院,有纤维蛋白(原)降解产物和D-二聚体等升高,无典型肺栓塞心电图表现,均曾漏诊急性肺血栓栓塞症,漏诊时间3~10 d。6例皆经CT肺动脉造影检查确诊急性肺血栓栓塞症,均接受抗凝治疗后病情好转出院。结论COPD合并急性肺血栓栓塞症缺乏特异性临床表现,容易漏诊;临床医师应加强对其认识,及时诊治,以减少或避免漏诊。Objective To explore the clinical characteristics of chronic obstructive pulmonary disease(COPD)combined with acute pulmonary thromboembolism,and to summarize the causes of misdiagnosis and measures to prevent misdiagnosis.Methods A retrospective analysis was conducted on the clinical data of 6 patients with acute pulmonary thromboembolism secondary to COPD who were misdiagnosed from January 2019 to October 2023.Results All 6 patients were admitted due to long-term cough,shortness of breath,and recent exacerbation,with elevated levels of fibrinogen degradation products and D-dimer.There were no typical pulmonary embolism on electrocardiogram,and acute pulmonary thromboembolism was missed in all cases.All 6 COPD patients had delayed diagnosis,with a minimum delay of 3 days and a maximum delay of 10 days.All 6 cases were diagnosed as acute pulmonary embolism by CT pulmonary angiography,and all received anticoagulant treatment.After treatment,their condition improved and they were discharged.Conclusion Acute pulmonary thromboembolism secondary to COPD is lack of specific clinical features,and the misdiagnosis rate is high.Clinicians should strengthen the understanding of the disease,and provide timely diagnosis and treatment,so as to reduce missed diagnosis.

关 键 词：肺疾病 慢性阻塞性 合并症 肺栓塞 漏诊 纤维蛋白原降解产物 D-二聚体 心电图 CT肺动脉造影 

分 类 号：R563.9[医药卫生—呼吸系统] R563.5[医药卫生—内科学]