母乳喂养带菌致婴儿腹泻的误诊原因分析  

Analysis of Causes of Misdiagnosis of Infantile Diarrhea Caused by Bacteria in Breast Milk

作　　者：田立新 张瑞永 TIAN Lixin;ZHANG Ruiyong(Department of Maternity and Maternity Health,Maternal and Child Health Care Hospital of Tongzhou District,Beijing 101101,China)

机构地区：[1]北京市通州区妇幼保健院孕产保健部,北京101101

出　　处：《临床误诊误治》2024年第13期1-5,共5页Clinical Misdiagnosis & Mistherapy

摘　　要：目的探讨母乳喂养带菌致婴儿腹泻的误诊原因,以提高婴儿腹泻的早期确诊率。方法回顾分析2021年7月至2023年7月收治的18例母乳喂养带菌致婴儿腹泻患儿的临床资料,检测婴儿血液学指标、粪便菌群及母乳中细菌,分析误诊经过,总结误诊原因及防范措施。结果在18例婴儿腹泻患儿中,分别有15例(83.33%)和8例(44.44%)出现发热和呕吐。患儿血液白细胞计数和中性粒细胞计数均升高。初步诊断为病毒性腹泻,给予补盐液、蒙脱石散及益生菌调理肠道菌群后发现腹泻症状明显减轻,但在停药后依然反复,经大便常规发现白细胞数量较高。实施病毒检测提示,患儿病毒检测为阴性。考虑母乳原因,对母乳中细菌水平进行检测。根据检测结果18例均确诊为感染性腹泻。误诊时间4~6 d。18例患儿均试停母乳喂养,在此基础上有15例(83.33%)口服益生菌治疗,有3例(16.67%)给予抗生素联合肠黏膜保护剂治疗;经48 h治疗后患儿均停止腹泻,复查大便正常。结论母乳喂养带菌致婴儿腹泻的原因较多,临床上应高度重视婴儿腹泻诊断的复杂性。在诊断过程中需完成必要的常规检查,及时给予母乳细菌检查和患儿血液学检查,以降低误诊率,避免给患儿造成严重后果。Objective To explore the causes of misdiagnosis of infantile diarrhea caused by bacteria in breast milk in order to improve the early diagnosis rate of infantile diarrhea.Methods Clinical data of 18 infants with infantile diarrhea caused by bacteria in breast milk admitted to our hospital from July 2021 to July 2023 were retrospectively analyzed.Hematological indicators,fecal flora and bacteria in breast milk were detected,misdiagnosis process was analyzed,and the causes of misdiagnosis and preventive measures were summarized.Results Among the 18 infants with diarrhea,15(83.33%)and 8(44.44%)had fever and vomiting,respectively.Both the leukocyte count and neutrophil count were elevated.The initial diagnosis was viral diarrhea.After giving appropriate amount of salt supplement solution,oral montmorillonite powder and probiotics to regulate intestinal flora,it was found that the infant's diarrhea symptoms were significantly alleviated.However,they continued to repeat after withdrawal of the drug,and a high number of white blood cells was found in stool routine.Virus detection was performed,and 12 cases were negative.Bacterial levels in breast milk were tested considering the cause of breast milk.According to the test results,all 18 infants were diagnosed with infectious diarrhea.The misdiagnosis lasted 4-6 d.For all the 18 infants,breast-feeding was stopped,and on this basis,15(83.33%)were treated with oral probiotics,while 3(16.67%)were treated with antibiotics combined with intestinal mucosal protective agents.At 48 h after treatment,all the children stopped experiencing diarrhea and had normal bowel movements upon re-examination.Conclusion There are many reasons for infantile diarrhea caused by bacteria in breast milk,and the complexity of diagnosis of infantile diarrhea should be highly valued in clinical practice.In the process of diagnosis,it is necessary to complete the necessary routine examination,and promptly perform bacteria examination in breast milk and children's hematology examination,in order to redu

关 键 词：腹泻 婴儿 母乳喂养 感染性腹泻 非感染性腹泻 误诊 病毒性腹泻 乳汁细菌检查 预后 

分 类 号：R722.132[医药卫生—儿科]