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目的 :分析急性肺动脉栓塞 (APE)误诊为急性非Q波心肌梗死 (NQMI)的因素 ,以期提高APE早期识别。方法 :回顾性分析我院近 3年来以“NQMI”收入院 ,经肺动脉造影确诊为“APE”的 6例患者 ,总结误诊原因。结果 :6例入院时均误诊为NQMI ,后经肺动脉造影确诊为“APE”。分析又发现 6例患者均有APE较为特征性表现 (如呼吸困难、窦性心动过速、P2 亢进 ) ,动脉血气显示低氧、低碳酸血症 ,心电图特征性改变———新出现的S1 ( >1 5mW )伴QⅢ 、TⅢ 和心电轴右偏而提示APE。结论 :由于APE非特异性的临床表现 (如胸闷、胸痛、心悸和出汗 )伴心电图的T波深倒置或ST -T改变及心肌酶升高的误导、同时又忽略了其相对特征的临床表现 (如呼吸困难、窦速、P2 亢进等 )和心电图改变 (SⅠ 或伴QⅢ 、TⅢ 和心电轴右偏 )是APE误诊为NQMI的主要原因。肺动脉造影目前仍是APE可靠的诊断方法。
Objective: To analyze the factors of misdiagnosis of acute pulmonary embolism (APE) as acute non-Q wave myocardial infarction (NQMI) in order to improve the early recognition of APE. Methods: A retrospective analysis of our hospital in the past 3 years to “NQMI” income hospital, confirmed by pulmonary arteriography as “APE” in 6 patients, summarizes the causes of misdiagnosis. Results: Six cases were misdiagnosed as NQMI on admission and were confirmed as APE by pulmonary angiography. Analysis also found that 6 patients had more characteristic manifestations of APE (such as dyspnea, sinus tachycardia, P2 hyperthyroidism), arterial blood gas showed hypoxemia, hypocapnia, ECG characteristic changes --- the emerging S1 (> 15mW) with QIII, TIII and right axis deviation ECG tips APE. CONCLUSIONS: Non-specific clinical manifestations of APEs such as chest tightness, chest pain, palpitations, and perspiration are associated with misdiagnosis of T-wave inversion or ST-T changes and elevated myocardial enzymes in ECG, while neglecting the clinical manifestations of their relative characteristics (Such as dyspnea, sinus speed, P2 hyperthyroidism, etc.) and ECG changes (S Ⅰ or with Q Ⅲ, T III and right axis deviation) are the main reasons for the misdiagnosis of APE as NQMI. Pulmonary angiography is still a reliable diagnostic method for APE.