休克型肺炎五例误诊分析及文献复习  

Misdiagnosis Analysis of Five Cases of Shock Pneumonia and Literature Review

作　　者：李瑞斌 郝玉梅 LI Rui-bin;HAO Yu-mei(Department of Intensive Care Unit,Hanxing Staff General Hospital of Minmetals,Handan,Hebei 056000,China)

机构地区：[1]五矿邯邢职工总医院重症监护室,河北邯郸056000

出　　处：《临床误诊误治》2020年第12期13-16,共4页Clinical Misdiagnosis & Mistherapy

摘　　要：目的分析休克型肺炎多系统临床表现及误诊原因,并总结防范误诊措施。方法回顾分析我院2017年2月—2019年4月收治的休克型肺炎5例误诊患者资料。结果5例中男3例,女2例;年龄9~72岁;春季发病2例,冬季发病3例。入院时有血压降低、面色苍白、四肢湿冷、脉细弱、心率快等休克表现,体温均升高,听诊有肺啰音3例、2例未闻及,血白细胞、中性粒细胞均升高。病初均因以非呼吸系统症状体征为主要表现,亦未及时行胸部X线及血液、痰菌培养,误诊为急性胃肠炎、急性胆道炎、急性心肌梗死、中毒性菌痢及病毒性脑炎各1例,误诊时间0.5~2 d,平均11.2 h。后经排除原始诊断并完善胸部X线及血液、痰菌培养后确诊为休克型肺炎。确诊后予纠正休克、抗感染、扩容、血管活性药物和糖皮质激素等治疗,7~14 d后治愈出院。结论对原因不明突然畏寒、发热、休克患者,即使呼吸道症状较轻微或虽无上述表现但有肺部感染征象,均应警惕休克型肺炎可能,详细询问病史,全面细致查体,熟知本病多系统表现,及时行胸部X线检查及血液、痰菌培养,有利于减少本病误诊的发生。Objective To analyze the multi-system clinical manifestations of shock pneumonia and the causes of misdiagnosis,and to summarize the prevention measures of misdiagnosis.Methods The data of 5 patients with shock pneumonia misdiagnosed as other diseases who were admitted to our hospital from February 2017 to April 2019 were retrospectively analyzed.Results Among the 5 cases,there were 3 males and 2 females,aged from 9 to 72 years,and 2 cases had onset in spring and 3 cases in winter.On admission,there were signs of shock such as decreased blood pressure,pale complexion,wet and cold limbs,weak pulse and rapid heart rate.The body temperature was increased.There were lung rales in 3 cases and no lung rales in 2 cases during auscultation.The white blood cells and neutrophils were increased.At the beginning of the illness,the main manifestations were non-respiratory symptoms and signs,and chest X-ray and blood and sputum culture were not performed in time.All patients were misdiagnosed as acute gastroenteritis,acute cholangitis,acute myocardial infarction,toxic bacillary dysentery and viral encephalitis,respectively.The duration of misdiagnosis was 0.5-2 days,with an average of 11.2 hours.After excluding the initial diagnosis and improving the chest X-ray,blood and sputum culture,the diagnosis of shock pneumonia was confirmed.After diagnosis,the patients were treated with correction of shock,anti-infection,volume expansion,vasoactive drugs and glucocorticoid,and were cured 7-14 days later.Conclusion For patients with unexplained sudden chills,fever and shock,even if the respiratory symptoms are mild or there are no signs of pulmonary infection despite the absence of the above-mentioned manifestations,we should be alert to the possibility of shock pneumonia.It is helpful to reduce the misdiagnosis of the disease by inquiring about the detailed medical history,conducting comprehensive and careful physical examination,being familiar with the multi-system manifestations of the disease,and timely carrying out chest X-ray exa

关 键 词：休克型肺炎 误诊 胃肠炎 心肌梗死 脑炎 病毒性 

分 类 号：R563.1[医药卫生—呼吸系统]