儿童腹型过敏性紫癜临床误漏诊分析  

Clinical Misdiagnosis and Missed Diagnosis of Children with Abdominal Anaphylactoid Purpura

作　　者：陈云 胡立杰 王婷婷 郝明明 CHEN Yun;HU Lijie;WANG Tingting;HAO Mingming(The Second Department of Comprehensive Pediatrics,the Fourth People's Hospital of Hengshui City,Hengshui,Hebei 053000,China;Department of Pharmacy,the Fourth People's Hospital of Hengshui City,Hengshui,Hebei 053000,China;the First Department of Comprehensive Pediatrics,the Fourth People's Hospital of Hengshui City,Hengshui,Hebei 053000,China;Department of Pediatric Internal Medicine,Hengshui People's Hospital,Hengshui,Hebei 053000,China)

机构地区：[1]衡水市第四人民医院综合儿科2,河北衡水053000 [2]衡水市第四人民医院药剂科,河北衡水053000 [3]衡水市第四人民医院综合儿科1,河北衡水053000 [4]衡水市人民医院小儿内科,河北衡水053000

出　　处：《临床误诊误治》2023年第5期11-14,共4页Clinical Misdiagnosis & Mistherapy

摘　　要：目的探讨儿童腹型过敏性紫癜(HSP)的临床特点、临床表现、鉴别诊断要点及误漏诊原因,并总结防范误漏诊措施。方法回顾分析2017年8月—2021年2月收治的初期曾误漏诊的腹型HSP患儿16例的临床资料。结果16例均以恶心呕吐、腹痛为主要症状就诊,查血白细胞计数升高12例,中性粒细胞百分比升高10例;尿红细胞阳性2例,便潜血试验阳性2例;3例行腹腔高频B超发现肠蛔虫。16例中误诊为急性阑尾炎8例,行阑尾切除术治疗,手术探查时发现阑尾正常,但腹部肠壁有水肿,浆膜充血且有散在分布淤斑,仔细查体发现有皮肤紫癜,遂确诊为腹型HSP;误诊为急性胃肠炎5例,予对症治疗后症状缓解不明显,行胃镜检查发现胃及十二指肠黏膜不同程度充血、水肿及散在大小不等的出血点,仔细查体发现有皮肤紫癜,遂确诊为腹型HSP;漏诊为肠道蛔虫病3例,予对症治疗后症状缓解不明显,仔细查体发现有皮肤紫癜,综合分析后均诊断为腹型HSP。误漏诊时间2~7 d。16例确诊后予卧床休息、脱敏等相关治疗,1个月后均临床治愈。结论对以腹痛、恶心呕吐等胃肠道症状为主诉就诊且未发现皮肤紫癜的患儿,应想到腹型HSP可能,应详细询问病史(致敏因素、腹痛性质程度等),细致查体,认真鉴别诊断,病程中可多次查体以发现晚于胃肠道症状出现的皮肤紫癜,早期行粪便检查、胃镜及纤维蛋白稳定因子检测,并全面分析病情,以及早确诊。Objective To investigate the clinical characteristics,clinical manifestations,differential diagnosis and causes of misdiagnosis and missed diagnosis in children with abdominal Henoch-Schonlein Purpura(HSP),and to summarize preventive measures for misdiagnosis and missed diagnosis.Methods The clinical data of 16 children with abdominal HSP who were initially misdiagnosed from August 2017 to February 2021 were retrospectively analyzed.Results Nausea,vomiting and abdominal pain were the main symptoms of 16 cases.Twelve cases had increased white blood cell count and 10 cases had increased neutrophil percentage.Urine erythrocyte test was positive in 2 cases,fecal occult blood test was positive in 2 cases,and ascaris eggs were positive in 3 cases.Intestinal ascariasis was detected by high-frequency B ultrasonography in abdominal cavity of 3 patients.In the 16 cases,8 cases were misdiagnosed as acute appendicitis,and the appendectomy was scheduled for treatment.During surgical exploration,the appendix was found to be normal,but there was edema in the abdominal intestinal wall,serous congestion and scattered distribution of ecchymosis.Careful physical examination revealed purpura,and the patient was diagnosed as abdominal HSP.Five cases were misdiagnosed as acute gastroenteritis,and the symptoms were not significantly relieved after symptomatic treatment.Gastroscopy revealed different degrees of hyperemia and edema in the gastric and duodenal mucosa and scattered hemorrhagic spots of different sizes.Careful physical examination revealed purpura,and the patient was diagnosed as abdominal HSP.Three cases of intestinal ascariasis were missed,and the symptoms were not significantly relieved after symptomatic treatment.Careful physical examination revealed purpura,which was diagnosed as abdominal HSP after comprehensive analysis.Misdiagnosis lasted from 2 to 7 d.Sixteen patients were given related treatment including bed rest and desensitization,all of which were cured clinically 1 month later.Conclusion For children with gas

关 键 词：紫癜 过敏性 腹型 儿童 误诊 阑尾炎 胃肠炎 蛔虫病 鉴别诊断 

分 类 号：R554.6[医药卫生—血液循环系统疾病]