Di Ricco G, Marini C, Rindi M, Melillo E, Vigotti M, Giuntini C
G Ital Cardiol. 1987 Feb;17(2):113-9.
Starting from 1969, the yearly number of patients with pulmonary embolism documented in the S. Chiara Hospital of Pisa is increased, in spite of the unchanged diagnostic procedures. Aim of this work is to verify if this trend is accompanied by earlier diagnosis with an improvement in the clinical outcome of pulmonary embolism, and if a relevant diagnostic failure is still present in our hospital. A comparison of pulmonary embolism cases collected from 1969 to 1971 and from 1980 to 1982 showed that the number of diagnoses made within one week from the onset of symptoms is increased (+24.8%), whereas the number of diagnoses made after more than one month is reduced (-18.1%). At the same time we observed that cases with a standard PaO2 less than 40 mmHg are reduced (-23.1%) while cases with a standard PaO2 greater than 50 mmHg are increased (+29.9%). An earlier diagnosis of pulmonary embolism contributed to treat a larger percentage of patients (+29.7%) and to lower the early mortality (-17.4%). This diagnostic trend can be ascribed to an increased readiness in raising the clinical suspicion of pulmonary embolism and to the prompt availability of perfusion lung scan, that is the center of our diagnostic strategy. Data of our 1,010 patients, compared with those of autoptic series and with the number of admissions, surgical operations and deaths in the wards of our hospital, suggest some persistent diagnostic failure in patients with well documented embolic risk; such as injured, burned, patients affected by neoplasm or motor lesion, patients operated for orthopedic or gynaecologic problems.
自1969年起，尽管诊断程序没有变化，但比萨圣基亚拉医院记录的每年肺栓塞患者数量仍在增加。这项工作的目的是验证这种趋势是否伴随着肺栓塞临床结局改善的更早诊断，以及我们医院是否仍然存在相关的诊断失误。对1969年至1971年以及1980年至1982年收集的肺栓塞病例进行比较发现，症状出现后一周内做出的诊断数量增加了（+24.8%），而一个多月后做出的诊断数量减少了（-18.1%）。同时我们观察到，标准动脉血氧分压（PaO2）低于40mmHg的病例减少了（-23.1%），而标准PaO2高于50mmHg的病例增加了（+29.9%）。肺栓塞的更早诊断有助于治疗更大比例的患者（+29.7%）并降低早期死亡率（-17.4%）。这种诊断趋势可归因于提高对肺栓塞临床怀疑的意愿增加以及灌注肺扫描的及时可用，灌注肺扫描是我们诊断策略的核心。我们1010例患者的数据，与尸检系列数据以及我们医院病房的入院、手术和死亡人数相比，表明在具有充分记录的栓塞风险的患者中存在一些持续的诊断失误；例如受伤、烧伤、患有肿瘤或运动损伤的患者，因骨科或妇科问题接受手术的患者。
