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目的:解读现行高原脑水肿(HACE)的诊断标准,总结我院住院病例并分析可能的误诊原因,进一步完善诊断流程。方法:对青海省人民医院2000年1月—2008年10月的住院拟诊HACE病患的诊断流程进行分析,结合有关文献探讨完善HACE的鉴别诊断,特别是HACE与脑血管病的关系。结果:检索出入院拟诊为HACE者共40例,最终确诊34例。其中预后良好31例,死亡3例均合并高原肺水肿(HAPE)。排除6例中,颅内感染(结核性脑膜脑炎、病毒性脑炎)3例,蛛网膜下腔出血1例,分水岭脑梗死1例,糖尿病高渗性昏迷1例。结论:临床应当遵循辨证和动态的诊断思维严格复核重症病例以利及时鉴别其他脑病特别是脑血管病。
OBJECTIVE: To interpret the current diagnostic criteria of high altitude brain edema (HACE), summarize the inpatients in our hospital and analyze the possible causes of misdiagnosis to further improve the diagnostic procedure. Methods: The diagnosis procedure of hospitalized patients with HACE from January 2000 to October 2008 in Qinghai Provincial People’s Hospital was analyzed, and the related literature was reviewed to improve the differential diagnosis of HACE, especially the relationship between HACE and cerebrovascular disease. Results: There were 40 cases with HACE admitted to hospital and 34 cases finally confirmed. Among them, 31 patients had good prognosis and 3 patients died of high altitude pulmonary edema (HAPE). Excluding 6 cases, intracranial infection (tuberculous meningoencephalitis, viral encephalitis) in 3 cases, subarachnoid hemorrhage in 1 case, watershed cerebral infarction in 1 case, diabetic hypertonic coma in 1 case. Conclusion: Clinical diagnosis should follow the dialectical and dynamic diagnostic thinking strict review of severe cases in order to facilitate the timely identification of other encephalopathy, especially cerebrovascular disease.