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
杨栋才 1任慧敏 1程家欣 1路晨阳 1卜丽娜 1刘志燕 1李楠 1贾卫红1
作者信息
- 1. 710083 西安,西北大学附属医院 西安市第三医院呼吸与危重症医学科
- 折叠
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7～10d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.
Abstract
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 oc-curred in 4 cases,respectively,chest pain in 1 case,syncope in 1 case and fever in 1 case.There was 1 cases of mild hypox-emia,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 angiogra-phy(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 pa-tients 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Key words
Pulmonary embolism/Aged,88 and over/Misdiagnosis/Pneumonia/Coronary heart disease/Respira-tory insufficiency/Angiography/Tomography,spiral computed引用本文复制引用
基金项目
西安市科技局项目(2017113SF/YX0072)
西安市卫健委项目(2021lyb41)
西安市卫健委项目(2021lyb42)
出版年
2023
国家科技期刊平台
NSTL
万方数据