儿童肺炎漏误诊原因分析——附65例尸检病理和临床资料  

To investigate the causes of misdiagnosis of pneumonia in children:analysis of the clinical and autopsy data of 65 cases

作　　者：陈晨[1] 彭艾芝[1] 王国丽[1] 彭镜[1] 尹飞[1] 

机构地区：[1]中南大学湘雅医院儿科,湖南长沙410008

出　　处：《临床儿科杂志》2012年第4期351-354,共4页Journal of Clinical Pediatrics

摘　　要：目的通过对65例尸检患儿病理与临床资料的总结分析,探讨儿童肺炎误诊、漏诊的原因。方法回顾性分析1990年至2008年间尸检病例中经临床或病理诊断为肺炎的65例患儿资料,按肺炎在病理诊断与临床诊断中的符合情况进行分组,分别对各组病例的临床表现、影像学检查、病理资料进行对照分析。结果临床与病理均诊断为肺炎者25例,临床未诊断为肺炎而病理诊断为肺炎者27例,临床诊断肺炎而病理否定者13例,肺炎正确诊断率仅为38.5%(25/65)。儿童肺炎的临床表现常不典型,与脓毒症、颅内感染、肺结核鉴别困难,各组患儿症状、体征相似;肺炎致死病例常合并其他基础疾病,以肺炎为主要致死病因者占13.5%(7/52),以其他疾病为主要致死病因者占7.7%(4/52),绝大多数由包括肺炎在内的多种疾病共同致死。仅56.9%(37/65)的患儿完善了肺部影像学检查。病理类型以支气管肺炎和间质性肺炎最为常见。结论儿童肺炎诊断须全面而综合,在临床工作中,除积极治疗肺部感染外,尚需重视其原发病和并发症。Objective To summarize and analyze the clinical and autopsy data of 65 cases for exploring the causes of misdiagnosis of pneumonia in children.Methods Sixty-five autopsy cases with clinical or pathological diagnosis of pneumonia from 1990 to 2008 were retrospectively reviewed.According to clinical and pathological diagnosis,the cases were divided to different groups.The clinical manifestation,imaging examination and pathological data were compared between different groups.Results Twenty-five cases were diagnosed with pneumonia both clinically and pathologically.Twenty-seven cases were diagnosed with pneumonia pathologically but not clinically.Thirteen cases were diagnosed with pneumonia clinically but not pathologically.The rate of correct diagnosis of pneumonia was only 38.5%（25/65）.The clinical manifestation of childhood pneumonia was atypical and it is difficult to be distinguished from sepsis,intracranial infection and pulmonary tuberculosis.Death cases of pneumonia often combined other underlying diseases.Pneumonia as the major death cause was 13.5%（7/52）and other diseases as the major death cause was 7.7%（4/52）.In majority of cases,the death was due to a variety of diseases including pneumonia.Only 56.9%（37/65）cases had lung imaging examination.The most common pathological types were bronchial pneumonia and interstitial pneumonia.Conclusions Diagnosis of pneumonia in children must be comprehensive and integrated.In clinic,in addition to treatment of lung infections,attention should be paid to the primary disease and complications.

关 键 词：肺炎 病理学 误诊 儿童 

分 类 号：R725.6[医药卫生—儿科]