围术期急性肺损伤临床误诊原因探讨  

Exploration of Cause of Clinical Misdiagnosis of Perioperative Acute Lung Injury

作　　者：蔡增华 吴昱 康晓芳 程建征 邵玉 于雄伟 CAI Zenghua;WU Yu;KANG Xiaofang;CHENG Jianzheng;SHAO Yu;YU Xiongwei(Department of Anesthesiology,the 980th Hospital of Joint Logistics Support Force of the PLA,Shijiazhuang 050082,China)

机构地区：[1]联勤保障部队第九八〇医院麻醉科,石家庄050082

出　　处：《临床误诊误治》2024年第16期10-15,共6页Clinical Misdiagnosis & Mistherapy

摘　　要：目的探讨围术期急性肺损伤的临床特点及误诊原因。方法回顾性分析2018年1月至2023年12月收治5例围术期急性肺损伤患者的临床资料。结果本组5例围术期发生不同程度的急性肺损伤,其中4例以低氧血症、窦性心动过速、ST段压低、气道压增高为首发症状(手术开始后2.5~3.0 h),初期误诊为急性心功能不全。1例经胸食管癌根治术患者以苏醒期呛咳、右双腔支气管导管总气管内出血为主要表现,初期误诊为气道损伤。5例误诊时间15~40 min。经多学科会诊,综合分析临床表现,结合肺纹理增多紊乱、肺水增多的影像学特征及术前相关并存疾病,诊断明确。确诊后经糖皮质激素抗炎、抗生素预防感染,控制液体入量、利尿减轻心肺负荷和水肿,补充胶体液、白蛋白提升胶体渗透压促进组织液回流,恢复良好。结论围术期急性肺损伤无特异性生物标志物和典型临床体征,诊疗过程中易发生误诊误治。临床医师应提高对此类疾病的警惕性,并做好针对性地教育培训,可有效避免临床误诊。Objective To explore the clinical characteristics and causes of misdiagnosis of perioperative acute lung injury(PALI).Methods The clinical data of 5 patients with PALI admitted from January 2018 to December 2023 were ret-rospectively analyzed.Results Different degrees of PALI occurred in 5 patients during operation.Among them,4 patients had hypoxemia,sinus tachycardia,ST segment depression,and increased airway pressure as the initial symptoms(2.5-3.0 h after the operation),and were initially misdiagnosed as acute cardiac insufficiency.The main manifestations of a patient un-dergoing radical resection for thoracoesophageal cancer were coughing and total endotracheal hemorrhage in the right double-lumen bronchial catheter during the recovery period,which was initially misdiagnosed as airway injury.The duration of misdi-agnosis of 5 patients was 15-40 min.After multidisciplinary consultation,comprehensive analysis of clinical manifestations,combined with the imaging features of increased lung texture disorder,increased lung water,and preoperative related co-existing diseases,the diagnosis was clear.After diagnosis,glucocorticoid anti-inflammatory and antibiotics were used to pre-vent infection,control fluid intake,diuresis to reduce cardiopulmonary load and edema,supplement colloidal fluid and albu-min to enhance colloid osmotic pressure and promote interstitial fluid return,and the recovery was good.Conclusion PALI lacks specific biomarkers and typical clinical signs,making it prone to misdiagnosis and mistreatment in the process of diagno-sis and treatment.Clinicians should enhance their vigilance towards such diseases and conduct targeted education and training to effectively avoid clinical misdiagnosis.

关 键 词：围术期 急性肺损伤 误诊 气道损伤 低氧血症 窦性心动过速 诊断 鉴别 

分 类 号：R563.9[医药卫生—呼吸系统]