大面积烧伤患者呕吐长条索状血凝块一例  

Vomiting long cord-like blood clot in large area burn patients: one case report

作　　者：田达 刘序友 黄海锋 舒泳翔 温琪 柏小芬 朱敏婕 王腾燕 舒建昌 Tian Da;Liu Xuyou;Huang Haifeng;Shu Yongxiang;Wen Qi;Bai Xiaofen;Zhu Minjie;Wang Tengyan;Shu Jianchang(Department of Gastroenterology,Guangzhou Red Cross Hospital Affiliated to Jinan University,Guangzhou 510220,China)

机构地区：[1]暨南大学附属广州市红十字会医院消化内科,广州510220 [2]贵州医科大学,贵阳550025

出　　处：《新医学》2021年第3期226-228,共3页Journal of New Medicine

基　　金：广东省卫生健康适宜技术推广项目(173);广州市临床重大技术项目(2019ZD19)。

摘　　要：大面积烧伤患者并发应激性溃疡出血较常见,该文报道1例在烧伤20余日后呕吐暗红色长条索状物质的患者,行急诊胃镜检查可见食管全段至胃幽门部黏膜充血明显,大量鲜红色血性液,于食道中下段见大片黏膜脱落,考虑诊断为应激性溃疡出血、食管管型。长条索状物质送检后病理证实为混合性血栓,未见明确胃食管黏膜。该例烧伤患者并发应激性溃疡出血后呕吐暗红色长条索状物质,临床表现极为罕见。该文针对误诊和出现特殊临床表现的原因进行分析,旨在供广大临床医务人员共同学习,加强对烧伤后应激性溃疡出血预防的重视,减少误诊,提高早期发现、诊治该病在特殊异常情况下的能力。Stress ulcer bleeding commonly occurs in patients with extensive burns. In this article, one patient who vomited a dark red long cord-like substance after more than 20 days of burns was reported. Emergency gastroscopy showed obvious congestion of the mucosa from the entire esophagus to the gastric pylorus. A large amount of bright red bloody fluid was seen in the middle and lower parts of the esophagus, and extensive mucosa fell off. The diagnosis of stress ulcer bleeding and esophageal tube type was considered. The long cord-like substance was pathologically confirmed to be mixed thrombus after examination, and no clear gastroesophageal mucosa was found. The clinical manifestations of this case were extremely rare, resulting in our misdiagnosis as an esophageal tube type. In this article, the causes of misdiagnosis and special clinical manifestations were analyzed, aiming to raise awareness of the special symptoms and signs of stress ulcer bleeding after burns, reduce the risk of misdiagnosis, and improve the ability of early detection, diagnosis and treatment of this disease by sharing this case with our peers.

关 键 词：烧伤 长条索状凝血块 应激性溃疡出血 食管管型 误诊 

分 类 号：R644[医药卫生—外科学] R573.1[医药卫生—临床医学]