临床容易忽视的高血钙危象三例报告并文献复习  

Hypercalcemic Crisis Which Tends to Be Clinically Overlooked(A Report of 3 Cases and the Literature Review)

作　　者：王越越[1] 朱海燕[1] 班雨[1] 宋扬[1] 孟庆义[1] 

机构地区：[1]解放军总医院急诊科,北京100853

出　　处：《临床误诊误治》2015年第1期23-27,共5页Clinical Misdiagnosis & Mistherapy

基　　金：军队医药卫生科研基金应用基础研究面上项目(CWS12J1250)

摘　　要：目的探讨高血钙危象的临床特点,总结诊治方法。方法回顾分析我科近期收治的3例高血钙危象的临床资料,并复习相关文献。结果本组3例均以运动、泌尿及神经等多系统临床症状急诊入院,血钙4.07~6.06 mmol/L,3例入院均诊断为高血钙危象。完善影像学及相关实验室检查结果以明确病因,1例病因为甲状旁腺腺瘤;1例为卵巢癌全身转移;1例高度怀疑恶性肿瘤,但病情进展迅速,未及明确病因即死亡。3例均行积极降血钙等对症处理,1例预后良好,2例死亡。结论高血钙危象的临床表现常累及神经、消化、泌尿、心血管、运动等多个系统,缺乏特异性;完善相关实验室及影像学检查可以防止误漏诊,使患者得到早期有效的诊治,提高生存率。Objective To explore clinical features of hypercalcemic crisis and share the experiences of diagnosis and treatment. Methods Clinical data of three patients with hypercalcemic crisis in our department were retrospectively analyzed and relevant literature were also reviewed. Results The three patients had all relating clinical symptoms,including motor system,urinary system,nervous system,etc. They were diagnosed with hypercalcemic crisis on admission,whose serum calcium was 4. 07-6. 06 mmol / L. Combined with the laboratory results and enhanced iconography findings,one patient was diagnosed as having parathyroid adenoma,one was confirmed as having malignant tumor with metastasis in multiple organs,and the etiology of the third patient was uncertain due to the rapid disease progression. The last one was highly suspected for malignancy.The three patients with hypercalcemic crisis were given positive symptomatic treatment. One patient had an excellent prognosis,but the other two died. Conclusion The patients of hypercalcemic crisis are always characteristic of varied clinical symptoms including nervous system,digestive system,urinary system and so on,with lack of specificity. Relevant laboratory and imaging examinations may be helpful in early diagnosis and effective treatment,avoiding misdiagnosis and missed diagnosis,and improving the patient＇s survival rate.

关 键 词：高钙血症 甲状旁腺功能亢进 原发性 卵巢肿瘤 漏诊 误诊 

分 类 号：R589.5[医药卫生—内分泌]