超高海拔急性肺栓塞肺梗死合并咯血患者误诊分析及文献复习  

Misdiagnosis Analysis and Literature Review of Patients with Acute Pulmonary Embolism and Pulmonary Infarction Combined with Hemoptysis at Ultra-high Altitude

作　　者：印显刚 邸丽改 王喜红 YIN Xiangang;DI Ligai;WANG Xihong(Department of Internal Medicine,People's Hospital of Ali District,Ali,Xizang Autonomous Region 859000,China;Department of Respiratory and Critical Care,the First Affiliated Hospital of Xi'an Medical College,Xi'an 710077,China)

机构地区：[1]阿里地区人民医院内科,西藏自治区阿里地区859000 [2]西安医学院第一附属医院呼吸与危重症医学科,西安710077

出　　处：《临床误诊误治》2025年第4期6-10,共5页Clinical Misdiagnosis & Mistherapy

摘　　要：目的分析超高海拔急性肺栓塞肺梗死合并咯血患者的临床特点及误诊原因,提高对急性肺栓塞的诊治能力。方法回顾分析2024年5月1例在超高海拔地区误诊为肺炎的急性肺栓塞肺梗死合并咯血患者的临床资料,并复习文献。结果本例以“咳嗽、咳痰15 d,左侧胸痛、气短、咯血1周,加重3 d”入院。患者为挖掘机司机,进入超高海拔地区工作1个月。患者就诊于多家医疗机构,误诊为肺炎合并咯血,给予抗感染及对症治疗,症状逐渐加重,最终行CT肺动脉造影确诊为急性肺栓塞肺梗死合并咯血。误诊时间1周。给予依诺肝素抗凝及对症治疗后病情好转出院。出院6个月后电话随访,患者常规抗凝治疗3个月后症状已完全消失。结论接诊超高海拔地区咯血、胸痛、呼吸困难患者需警惕急性肺栓塞继发肺梗死可能,急性肺栓塞肺梗死合并咯血患者需根据咯血病因和咯血量等因素制订个体化治疗方案。Objective To analyze the clinical characteristics and causes of misdiagnosis in patients with acute pulmonary embolism(APE)and pulmonary infarction combined with hemoptysis at ultra-high altitude,so as to improve the diagnosis and treatment of APE.Methods The clinical data of a patient with APE and pulmonary infarction combined with hemoptysis misdiagnosed as pneumonia at ultra-high altitude in May 2024 were retrospectively analyzed and a literature review was performed.Results The patient was admitted with cough and sputum for 15 days,left chest pain,shortness of breath,and hemoptysis for 1 week,which were aggravated for 3 days.The patient was an excavator driver who had been working in an ultra-high altitude area for one month.The patient was treated in several medical institutions and misdiagnosed as pneumonia combined with hemoptysis.Anti-infection and symptomatic treatment were given,but the symptoms gradually worsened.Finally,CT pulmonary angiography confirmed APE with pulmonary infarction combined with hemoptysis.The misdiagnosis lasted 1 week.After Enoxaparin anticoagulation and symptomatic treatment,his condition improved and he was discharged.At 6 months after discharge,the patient was followed up by telephone,and the symptoms had completely disappeared at 3 months after routine anticoagulant treatment.Conclusion For patients with hemoptysis,chest pain and dyspnea in ultra-high altitude areas,clinicians should be alert to the possibility of secondary pulmonary infarction caused by APE.For patients with APE combined with hemoptysis,individualized treatment plans should be developed according to factors such as the cause and the amount of hemoptysis.

关 键 词：肺栓塞 肺梗死 咯血 超高海拔 误诊 肺炎 CT肺动脉造影 鉴别诊断 

分 类 号：R543.2[医药卫生—心血管疾病]