关键词: 肺栓塞, 误诊, 临床特征

Abstract: Objective　To compare diagnostic delays and clinical features between outpatient and non-outpatient patients with primary diagnosis of acute pulmonary embolism，so as to improve the diagnosis of acute pulmonary embolism in outpatient clinics.Methods　A total of 110 patients with acute pulmonary embolism admitted to Shanghai Ninth People's Hospital，Shanghai Jiao Tong University School of Medicine from January 2015 to August 2017 were selected as subjects.According to the first visiting department，they were divided into initial outpatient group（n=40） and initial non-outpatient group（n=70）.The general information，diagnosis，clinical manifestations，risk factors，cardiac damage and prognosis were recorded.Results　There was significant difference between two groups in gender，time from onset to diagnosis，the proportion of misdiagnosed patients in initial diagnosis，misdiagnosed as pneumonia and misdiagnosed as acute exacerbation of chronic obstructive pulmonary disease（P<0.05），but no significant difference in age，serum D-two dimer level and the proportion of patients who were misdiagnosed as coronary heart disease（P>0.05）.There was significant difference between two groups in the proportion of patients with dyspnea，chest tightness，cough and hypoxia（P<0.05）.but no significant difference in the proportion of patients with chest pain，fever，hemoptysis，syncope，shock，unilateral limb pain or swelling（P>0.05）.There was significant difference between two groups in the proportion of patients with recent operation history，short-term immobilization，and combination of tumor and stroke（P<0.05），but no significant difference in the proportion of patients combined with deep vein embolism，lower extremity fracture or trauma，infection，chronic cardiopulmonary disease，hypertension and diabetes mellitus（P>0.05）.There was significant difference between two groups in the proportion of patients with sinus tachycardia by electrocardiogram（P<0.05），but no significant difference in the proportion of patients with right ventricular dysfunction，elevated serum troponin T or B type natriuretic peptide，atrial fibrillation，ST-segment depression or T-wave inversion，complete right bundle branch block，SIQ3T3 and 30-day mortality（P>0.05）.Conclusion　The symptoms of patients with acute pulmonary embolism who are initially diagnosed at outpatient clinics are usually atypical and lack obvious predisposing factors，which may lead to delayed diagnosis or misdiagnosis.The proportion of patients with diagnosis delay in outpatient clinics was higher than non-outpatient patients.

Key words: Pulmonary embolism, Diagnostic errors, Clinical features