摘要
目的 :通过调查我国肺栓塞误诊患者辅助检查状况 ,分析误诊原因 ,强调临床医师诊断肺栓塞时进行辅助检查的重要性 ,以减少肺栓塞的误诊、漏诊。 方法 :通过中国生物医学文献数据库 (CBMdisc)检索 1980年 1月～ 2 0 0 1年 6月发表与肺栓塞误诊有关的文献 3 7篇 ,对被误诊 3 10例肺栓塞患者的四项辅助检查 ,包括化验室检查、心电图、X线胸片、超声心动图进行了回顾性调查研究。 结果 :①总计对四项辅助检查所涉及的 3 2项指标进行了调查 ,其中化验室检查 6项指标 ,心电图描记 10项指标 ,超声心动图 7项指标 ,X线胸片 9项指标。文献中对 3 2项指标作了不同程度的调查描述 ,描述清楚者仅有X线肺部阴影、动脉血氧分压两项指标的调查例数 (分别为 188例及 156例 )超过了调查总例数 (3 10例 )的 50 % (分别为 60 6%、50 3 % )。②检查阳性率超过 50 %以上的有 :化验室检查中血气分析动脉血氧分压及二氧化碳分压下降分别为 60 9%、 74 6% ,外周血白细胞计数及血清酶升高分别为 53 5%、 59 4%。心电图表现窦性心动过速、V1～ 6 T波低平或倒置、ST段压低分别为 80 0 %、 56 0 %、 52 5% ,SⅠ QⅢTⅢ 仅为 3 7 1%。超声心动图肺动脉高压为60 9%。X线胸片 9项检查指标中阳性率无超过 50 %者 ,以肺部阴?
Objective:To investigate the 20-year accessory examinations and causes of mi sdiagnosed pulmonary embolism (PE) in China,and to emphasize the imprtance of ac cessory examination when diagnosing PE at basic hospitals. Methods:Thirty-seven documents of Chinese-language case studies on PE misdia gnosis published between January 1980 and June 2001 were reviesed using the Chin ese Biomedical Literature Database (CBMdisc).Retrospective review of 4 classes o f accessory examinations,including laboratory examinations,electrocardiography ( ECG),chest X-rays,and echocardiography was made in 310 PE patients. Results:①Thirty-two parameters of 4 classes of examinations were in vestigated;6 in laboratory examinations,10 in ECG,7 in echocardiography,and 9 in chest X-ray.Only two parameters (Lung shadow of X-rays and partial pressure of oxygen in arterial blood) were described clearly,with the investigate case numbe r being 188 (60.6%) and 156(50.3%),respectively.②The positive examination rat es>50% were as follows:the partial pressure of oxygen in arterial bolld and par tial pressure of carbon dioxide were reduced by 60.9% and 74.6%,respectively;t he peripheral white blood cell and serum enzyme were increased by 53.5% and 59. 4%,respectively;the incidence rates of sinus tachycardia,T wave changes in V 1-6 and ST segment depression were 80.0%,56.0% and 52.5%,respectively;onl y 37.1% of the patients presented with S ⅠQ ⅡT Ⅲ pattern changes;60.9% o f pulmonary hypertension was noted on echocardiography;none of the positive rate s of the 9 parameters for chest X-rays was beyond 50%,with predominant lung sha dow amounting to 35.1%,③No abnormal evidence was fourd from the above accessor y exanination reports. Conclusions:Chinese doctors often overlooked the abnormal result s of accessory examinations for PE patients,thus leading to PE misdiagnosis.Labo ratory,ECG,chest X-rays,and echocardiographic examintions can be routinely used for screening PE,which is helpful for the preliminary PE diagnosis.
出处
《中国循环杂志》
CSCD
北大核心
2003年第5期358-361,共4页
Chinese Circulation Journal
关键词
中国
肺栓塞
误诊
原因
调查
漏诊
Pulmonary embolism
Diagnosis
Diagnostic error s
Accessory examination
