临床误诊误治
臨床誤診誤治
림상오진오치
Clinical Misdiagnosis & Mistherapy
2015年
10期
42-45
,共4页
咳嗽%误诊%咽炎%支气管炎%诊断
咳嗽%誤診%嚥炎%支氣管炎%診斷
해수%오진%인염%지기관염%진단
Cough%Misdiagnosis%Pharyngitis%Bronchitis%Diagnosis
目的：提高慢性咳嗽病因鉴别诊断能力,以减少误诊误治。方法回顾性分析2012年1月—2013年12月我院因慢性咳嗽就诊的117例临床资料。结果117例均以慢性咳嗽为主诉,病程6~36个月。其中56例(47．86%)为明显的夜间刺激性咳嗽,33例(28.21%)为以白天为主的发作性咳嗽,16例(13.68%)为慢性刺激性干咳或咳少许黏痰,12例(10.26%)仅为干咳。多数患者伴有咽痒、胸闷、咳痰、胃灼热、胸痛、恶心,个别伴有低热。本组外院就诊2~5次,均误诊,误诊疾病：支气管炎70例(59.83%)、咽炎47例(40.17%)。就诊我院后经完善相关医技检查明确病因,其中43例(36.75%)病因为咳嗽变异性哮喘,17例(14.53%)为上气道咳嗽综合征,14例(11．97%)为嗜酸粒细胞性支气管炎,13例(11.11%)为胃食管反流病,11例(9.40%)为变应性咳嗽,8例(6.84%)为血管紧张素转换酶抑制剂相关性咳嗽,2例(1.71%)为肺癌,9例(7.69%)病因不明。结论慢性咳嗽病因复杂,易发生过度治疗。临床医师对慢性咳嗽患者应拓宽诊断思路,不应仅满足于咽炎和支气管炎的诊断,完善相关医技检查,及早明确病因,避免造成不良后果。
目的：提高慢性咳嗽病因鑒彆診斷能力,以減少誤診誤治。方法迴顧性分析2012年1月—2013年12月我院因慢性咳嗽就診的117例臨床資料。結果117例均以慢性咳嗽為主訴,病程6~36箇月。其中56例(47．86%)為明顯的夜間刺激性咳嗽,33例(28.21%)為以白天為主的髮作性咳嗽,16例(13.68%)為慢性刺激性榦咳或咳少許黏痰,12例(10.26%)僅為榦咳。多數患者伴有嚥癢、胸悶、咳痰、胃灼熱、胸痛、噁心,箇彆伴有低熱。本組外院就診2~5次,均誤診,誤診疾病：支氣管炎70例(59.83%)、嚥炎47例(40.17%)。就診我院後經完善相關醫技檢查明確病因,其中43例(36.75%)病因為咳嗽變異性哮喘,17例(14.53%)為上氣道咳嗽綜閤徵,14例(11．97%)為嗜痠粒細胞性支氣管炎,13例(11.11%)為胃食管反流病,11例(9.40%)為變應性咳嗽,8例(6.84%)為血管緊張素轉換酶抑製劑相關性咳嗽,2例(1.71%)為肺癌,9例(7.69%)病因不明。結論慢性咳嗽病因複雜,易髮生過度治療。臨床醫師對慢性咳嗽患者應拓寬診斷思路,不應僅滿足于嚥炎和支氣管炎的診斷,完善相關醫技檢查,及早明確病因,避免造成不良後果。
목적：제고만성해수병인감별진단능력,이감소오진오치。방법회고성분석2012년1월—2013년12월아원인만성해수취진적117례림상자료。결과117례균이만성해수위주소,병정6~36개월。기중56례(47．86%)위명현적야간자격성해수,33례(28.21%)위이백천위주적발작성해수,16례(13.68%)위만성자격성간해혹해소허점담,12례(10.26%)부위간해。다수환자반유인양、흉민、해담、위작열、흉통、악심,개별반유저열。본조외원취진2~5차,균오진,오진질병：지기관염70례(59.83%)、인염47례(40.17%)。취진아원후경완선상관의기검사명학병인,기중43례(36.75%)병인위해수변이성효천,17례(14.53%)위상기도해수종합정,14례(11．97%)위기산립세포성지기관염,13례(11.11%)위위식관반류병,11례(9.40%)위변응성해수,8례(6.84%)위혈관긴장소전환매억제제상관성해수,2례(1.71%)위폐암,9례(7.69%)병인불명。결론만성해수병인복잡,역발생과도치료。림상의사대만성해수환자응탁관진단사로,불응부만족우인염화지기관염적진단,완선상관의기검사,급조명학병인,피면조성불량후과。
Objective To investigate the cause of misdiagnosis and the mistreatment of chronic cough. Methods The clini-cal data of 117 cases of chronic cough treated in our hospital during January 2012 and December 2013 were analyzed retrospectively. Results 117 cases complained of chronic cough and the course was 6-36 months, including 56 cases (47. 86%) of obvious nighttime irritating cough, 33 cases (28. 21%) with daytime paroxysmal cough, 16 cases (13. 68%) of chronic irritant dry cough or cough with a little sticky phlegm, 12 cases (10. 26%) of only a dry cough. Most of the patients complained of an itchy throat, chest tightness, chest pain, nausea, heartburn, expectoration, sometimes accompanied with a low fever. This group of patients had visited other hospi-tals 2 to 5 times, and all were misdiagnosed, including:70 cases (59. 83%) of bronchitis, 47 cases (40. 17%) of pharyngitis. In our (36. 75%) of cough variant asth-ma, 17 cases ( 14. 53%) of upper airway cough syndrome, 14 cases ( 11. 97%) of eosinophil; eosinophil bronchitis, 13 cases (11. 11%) of esophageal and gastric anti reflux disease, 11 cases (9. 40%) of allergic cough, 8 cases (6. 84%) of an angiotensin converting enzyme inhibitor related cough, 2 cases (1. 71%) of lung cancer, 9 cases (7. 69%) of unknown etiology. Conclusion The cause of chronic cough is complex, and excessive treatment is often reported. Clinicians should broaden their view of diagnosis of chronic cough, avoid attributing it to only pharyngitis and bronchitis. Relevant medical examination techniques should be improved to make early diagnosis and avoid adverse consequences.
