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随结核病疫情的下降,血行播散型肺结核(血播肺结核)已较少见,其发病年龄后移,临床特征改变,加以其它因素,致诊断常有延误.为此,总结我院近10年64例急性血行播散型肺结核中延误诊断者52例,以探讨延误诊断原因.寻找对策,以骥提高早期诊断水平.1 临床资料1.1 延误诊断标准患者延误:指出现症状至首次就诊时间≥15天;医生延误:指首次就诊至确诊时间≥15天;综合延误:指两种延误时间之和.1.2 一般资料52例为我院住院患者,诊断以胸片肺部粟粒阴影并经治疗观察证实36例,病原学检查证实6例,纤支镜刷检、活检、灌洗确诊5例,淋巴结活检3例,死后肺组织病理确诊2例.其中男27例,女25例;年龄3个月～72岁,平均30.8岁;农村患者43例,城镇9例;首诊于综合医院48例(92.3%),结防机构4例(7.7%),有结核病既往史4例,家族史5例;急性起病39例(75%),亚急性及慢性起病13例(25%).转归:死亡6例(11.5%),恶化6例,好转40例.1.3 肺外结核情况并发结脑21例(40.4%),肾结核2例,副睾结核2例,淋巴结核3例,肝、骨结核各1例,计30例(57.7%).明显高于我院住院肺结核患者并发肺外结核5.4%的总体率(经x~2检验,P<0.01).1.4 临床症状发热45例,其中高热37例(86.5%).咳嗽31例(59.6%),咳痰9例,胸闷13例,消瘦20例,头痛17例,呕吐16例,昏迷、抽搐各3例,闭经6例,关节痛、腰痛各2例.
With the decline of tuberculosis, hematogenous disseminated tuberculosis (blood borne tuberculosis) has been rare, the age of onset of the shift, changes in clinical features, to other factors, resulting in the diagnosis of often delayed.To this end, summarize our hospital for nearly 10 years 64 cases of acute hematogenous disseminated pulmonary tuberculosis in 52 cases of delayed diagnosis in order to explore the causes of delayed diagnosis.To find countermeasures to improve the early diagnosis of Ji level.1 Clinical data 1.1 Delayed diagnostic criteria Patients with delay: refers to the symptoms until the time of the first visit ≥ 15 Days; doctor delay: refers to the time of first visit to the diagnosis of ≥ 15 days; comprehensive delay: refers to the sum of two delays.1.2 General Information 52 cases of hospitalized patients in our hospital, diagnosed with chest shadow lung miliary shadow and confirmed by treatment observation 36 cases were confirmed by etiological examination, 6 cases were diagnosed by fiberoptic bronchoscopy, 5 cases were diagnosed by biopsy and lavage, 3 cases were lymph node biopsy, 2 cases were pathologically diagnosed after death, including 27 males and 25 females; Months to 72 years old, with an average of 30.8 years old; 43 rural patients, 9 towns; first diagnosed in 48 hospitals (92.3%), 4 cases of tuberculosis prevention and treatment institutions (7.7%), 4 cases of past history of tuberculosis, Cases: acute onset in 39 cases (75%), subacute and chronic onset in 13 cases (25%). Outcomes: 6 cases of death (1 1.5%), exacerbation in 6 cases, improvement in 40 cases.31 cases of extrapulmonary tuberculosis complicated with nodular brain in 21 cases (40.4%), 2 cases of renal tuberculosis, 2 cases of epididymal tuberculosis, 3 cases of lymph node tuberculosis, liver and bone tuberculosis in 1 case (P <0.01) .1.4 The clinical symptoms of fever in 45 cases, of which 37 cases of high fever (37.7%) were significantly higher than the hospitalized patients with pulmonary tuberculosis in our hospital complicated by pulmonary tuberculosis (5.4% 86.5%). Cough in 31 cases (59.6%), sputum in 9 cases, chest tightness in 13 cases, weight loss in 20 cases, headache in 17 cases, vomiting in 16 cases, coma and convulsion in 3 cases, amenorrhea in 6 cases, example.