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目的探讨慢性阻塞性肺疾病(COPD)合并肺血栓栓塞症(PTE)易患因素、临床特点及误诊原因。方法回顾2005-01-2010-11收治COPD 3 260例,合并PTE 535例,误诊15例。结果误诊时间3～7d,平均(4.5±2)d;12例有双心病;9例呼吸困难加重;8例咯血;8例发热、血压低;12例动脉血气Pa(A-a)O2增高;13例纤维蛋白原升高。结论误诊原因:(1)COPD特点:肺部血管壁损伤、纤维蛋白原升高,血流速度减慢;(2)与低灌注有关;(3)与COPD症状学混淆;(4)对理化检查认识不够。
Objective To investigate the risk factors, clinical features and misdiagnosis of chronic obstructive pulmonary disease (COPD) complicated with pulmonary thromboembolism (PTE). Methods The data of 3 260 COPD patients, 535 patients with PTE and 15 misdiagnosed patients were retrospectively reviewed from January 2005 to November 2010. Results The time of misdiagnosis was 3 ~ 7 days, with an average of (4.5 ± 2) days. Twelve patients had bilateral heart disease, 9 patients had dyspnea, 8 had hemoptysis, 8 had fever and had low blood pressure. Cases of fibrinogen increased. Conclusions Misdiagnosis causes: (1) COPD features: pulmonary vascular wall injury, fibrinogen increased blood flow slowed down; (2) and low perfusion; (3) and COPD symptomology confusion; (4) Insufficient understanding