急性重症胰腺炎七例误诊原因分析  

Causes of Misdiagnosis in 7 Cases with Severe Acute Pancreatitis

作　　者：李静[1] 徐宁[1] LI Jing;XU Ning(Department of Critical Care Medicine,the Second Hospital of Yulin,Yulin,Shaanxi 719000,China)

机构地区：[1]榆林市第二医院重症医学科

出　　处：《临床误诊误治》2019年第7期1-4,共4页Clinical Misdiagnosis & Mistherapy

基　　金：陕西省卫生厅科研基金项目(2015JM4029)

摘　　要：目的分析急性重症胰腺炎的误诊原因,提高临床诊治水平。方法回顾性分析2016年2月—2017年10月我院7例急性重症胰腺炎误诊病例资料。结果本组因畏寒腹痛、发热腹痛、呕吐腹泻入院各1例,腹痛入院4例,7例误诊时间14h^3d,误诊为感染性休克合并结石性胆囊炎、急性胃肠炎合并低血容量性休克各2例,泌尿系统结石、胆道蛔虫症、消化道穿孔各1例。所有患者按误诊疾病给予治疗效果不佳,后经血尿淀粉酶检查及影像学检查均确诊为急性重症胰腺炎。确诊后均予禁食、抑制胰液分泌、抗感染、手术等治疗后好转出院。结论临床医生应加强对急性重症胰腺炎的认识,详细问诊,仔细查体,对疑似患者及时行血尿淀粉酶检查排查本病,或可减少或避免误诊的发生。Objective To analyze the causes of misdiagnosis of severe acute pancreatitis (SAP) and to improve the level of clinical diagnosis and treatment. Methods The clinical data of 7 cases with SAP misdiagnosed in our hospital from February 2016 to October 2017 were retrospectively analyzed. Results In this group, 1 case was admitted to hospital with intolerance of cold and abdominal pain, 1 was admitted with fever and abdominal pain, 1 was admitted with vomiting and diarrhea, and 4 were admitted with abdominal pain.The duration of misdiagnosis of 7 cases was 14 h-3 d, including 2 cases misdiagnosed as septic shock with calculous cholecystitis, 2 as acute gastroenteritis with hypovolemic shock, 1 as lithiasis in urinary system, 1 as biliary ascaris, and 1 as gastrointestinal perforation. All patients were treated according to misdiagnosed disease and the effect was not good. All patients were finally diagnosed with SAP by serum, urine amylase and imaging examination. After diagnosis, they were discharged after treatment including fasting, inhibition of pancreatic secretion, anti-infection and surgery. Conclusion Clinicians should strengthen the understanding of SAP, with detailed consultation and careful examination. Hematuria amylase examination should be performed timely on suspected patients to check the disease, by which misdiagnosis can may be reduced or avoided.

关 键 词：胰腺炎 误诊 胆囊炎 休克 

分 类 号：R576[医药卫生—消化系统]