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

摘要： 目的　比较经门诊初诊和非门诊初诊入院的急性肺栓塞患者的诊断延误情况及临床特征，以提高门诊接诊急性肺栓塞的认知。方法　选取2015年1月—2017年8月在上海交通大学医学院附属第九人民医院住院的急性肺栓塞患者110例为研究对象。根据急性肺栓塞发病及就诊情况，将110例患者分为门诊初诊组（n=40）和非门诊初诊组（n=70）。记录患者一般资料、诊断情况、临床表现、易患因素、心脏损害、预后等情况。结果　两组患者性别、发病至确诊时间、初诊误诊的患者比例、初诊误诊为肺炎、初诊误诊为慢性阻塞性肺疾病急性加重的患者比例比较，差异有统计学意义（P<0.05）；两组患者年龄、血清D-二聚体水平、初诊误诊为冠心病的患者比例比较，差异无统计学意义（P>0.05）。两组临床表现为呼吸困难、胸闷、咳嗽、缺氧的患者比例比较，差异有统计学意义（P<0.05）；两组临床表现为胸痛、发热、咯血、晕厥、休克、单侧肢体疼痛或肿胀的患者比例比较，差异无统计学意义（P>0.05）。两组有近期手术史、近期制动、合并肿瘤、合并脑卒中的患者比例比较，差异有统计学意义（P<0.05）；两组合并深静脉栓塞、下肢骨折/创伤、感染、慢性心肺疾病、高血压、糖尿病的患者比例比较，差异无统计学意义（P>0.05）。两组心电图表现为窦性心动过速的患者比例比较，差异有统计学意义（P<0.05）；两组心脏超声提示右心功能障碍、血清肌钙蛋白T/B型尿钠肽增高、心电图表现为心房颤动、胸导联ST段压低或T波倒置、完全性右束支传导阻滞、SIQ3T3的患者比例及30 d死亡率比较，差异无统计学意义（P>0.05）。结论　初诊在门诊就诊的急性肺栓塞的症状不典型，常缺少明显的易患因素，出现诊断延迟或误诊的患者比例高于非门诊初诊患者。

关键词: 肺栓塞, 误诊, 临床特征