重症急性胰腺炎误诊原因分析  

Misdiagnosed Analysis of Severe Acute Pancreatitis

作　　者：王辉 康志龙 彭新华 刘丽梅 刘英雪 封英杰 陶丽娟 WANG Hui;KANG Zhi-long;PENG Xin-hua;LIU Li-mei;LIU Ying-xue;FENG Ying-jie;TAO Li-juan(Department of Gastroenterology,the Hospital of Xinle City,Xinle,Hebei 050700,China;Department of General Surgery,the Hospital of Xinle City,Xinle,Hebei 050700,China;Emergency Department,the Sixth People's Hospital of Hengshui,Hengshui,Hebei 053000,China;Department of Gastroenterology,the First Hospital of Sanhe Yanjiao Fuhe,Langfang,Hebei 065201,China;Department of Gastroenterology,the People's Hospital of Shijiazhuang City,Shijiazhuang 050000,China;Department of Internal Medicine,Qian'an Yanshan Hospital,Tangshan,Hebei 053000,China)

机构地区：[1]新乐市医院消化内科,河北新乐050700 [2]新乐市医院普外科,河北新乐050700 [3]衡水第六人民医院急诊科,河北衡水053000 [4]三河燕郊福合第一医院消化内科,河北廊坊065201 [5]石家庄市人民医院消化内科,石家庄050000 [6]迁安燕山医院内科,河北唐山053000

出　　处：《临床误诊误治》2021年第12期12-15,共4页Clinical Misdiagnosis & Mistherapy

基　　金：河北省中医药管理局科研计划项目(2019474)。

摘　　要：目的分析重症急性胰腺炎(SAP)的临床特点及误诊原因,以避免误诊误治。方法回顾分析2018年2月—2020年2月16例入院初期误诊SAP的临床资料。结果本组误诊率为17.58%。16例均有不同程度持续性腹痛伴恶心,10例血淀粉酶升高。本组误诊为肠梗阻5例,弥漫性腹膜炎4例,胆道感染及胆石症各3例,感染性休克合并急性胆囊炎1例。误诊时间2.2~4.1 d。患者按误诊疾病治疗后,病情均未见好转,后行腹部CT增强扫描并复查血淀粉酶升高,确诊为SAP,确诊后给予禁食禁水、持续胃肠减压、呼吸机辅助呼吸、连续床旁血液净化、抑制胰腺分泌、抗休克、抗感染、补液及营养支持等治疗,住院26~43 d后痊愈出院。结论SAP病因多,症状体征无特异性,部分患者早期血尿淀粉酶不高或轻微升高,易发生误诊误治;临床医生应提高警惕,认真鉴别诊断,及早行腹部CT增强扫描,以提高诊断准确性。Objective To analyze clinical characteristics and causes of misdiagnosed patients with severe acute pancreatitis(SAP)in order to avoid misdiagnosis and mistreatment.Methods Clinical data of 16 patients with SAP misdiagnosed at the initial stage of admission between February 2018 and February 2020 was retrospectively analyzed.Results The misdiagnosis rate was 17.58%.All 16 patients had different degrees of persistent abdominal pain with nausea,and 10 patients had elevated blood amylase.Among them,5 patients were misdiagnosed as having intestinal obstruction,4 patients as having diffuse peritonitis,3 patients as having biliary tract infection,3 patients as having cholelithiasis,and 1 patient as having septic shock complicated combined with acute cholecystitis.The misdiagnosed duration was 2.2-4.1 d.After treatment according to the misdiagnosed diseases,patients'conditions did not improve.After abdominal enhanced CT scanning and reexamination of levels of blood amylase that were proved to be increased,SAP was confirmed in all patients.After confirming diagnosis,the patients were treated with fasting and water deprivation,continuous gastrointestinal decompression,ventilator-assisted breathing,continuous bedside blood purification,inhibition of pancreatic secretion,anti-shock and anti-infection treatments,fluid replacement and nutritional support.They all cured and were discharged after hospitalization for 26-43 d.Conclusion There are many causes of SAP occurrence,and symptoms and signs are non-specific.Some patients have no high or slightly elevated hematuria amylase at early stage,which is prone to misdiagnosis and mistreatment.Clinicians should be vigilant,and carefully differential diagnosis and early abdominal enhanced CT scanning should be performed in order to improve the accuracy of diagnosis.

关 键 词：重症急性胰腺炎 误诊 肠梗阻 弥漫性腹膜炎 胆石症 胆囊炎 急性 

分 类 号：R576[医药卫生—消化系统]