隐匿性肺炎的隐匿原因与预防(附27例法医尸解报告)

Precaution of Occult-pneumonia(Cause Analysis on 27 Forensic Autopsies)

目的:探讨"隐匿性肺炎"的隐匿原因,提出减少此类病人死亡的措施。方法:对四川大学华西法医学鉴定中心1999～2008年经尸体解剖证实的27例"隐匿性肺炎"的资料进行回顾性分析。结果:27例"隐匿性肺炎"中男16例,女11例;年龄分布上有≤5岁、≥60岁2个高峰期。就诊医院以乡镇卫生院及县级医院为主,科室分布以神经外科及儿科为主。19例(70.4%)以并发症形式出现,原发病症以颅脑损伤多见。全部案例均无咳嗽、咳痰等呼吸道症状,其中6例(22.2%)以腹泻、腹痛、全身皮疹等肺外症状为唯一表现,最终误诊为肠炎、阑尾炎及荨麻疹。15例(55.6%)为小叶性肺炎,累及2～3个肺叶,病灶多位于双肺下叶基底部或背部;10例(37.0%)为间质性肺炎,累及3～5个肺叶;2例(7.4%)为大叶性肺炎,累及2～3个肺叶。结论:肺炎隐匿与多种因素有关,加强对肺炎隐匿因素的认识与关注可减少"隐匿性肺炎"死亡的发生。

Objective： To analyze the cause of occult-pneumonia and introduce preventive measures to reduce mortality rate. Methods：The data of the 27 death cases from occult-pneumonia eomfired by autopsy in our department from 1999 to 2008 were retrospectively analyzed. Results：In the 27 occult-pneumonia death cases,there were 16 males and 11 females. 2 peaks for the curve of age distribution were children≤5y and elderly people ≥60y. Hospitals where the patients were hospitalized were maily township health centers and county hospitals and the departments were mainly neurosurgical departments and pediatrics departments. Of the 27 occultpneumonia patients, 19 patients（70. 4% ）showed complications and primary diseases were characterized by head injury. No patient had symptoms such as cough and expectoration. 6 patients （22. 2% ）were only characterized by diarrhea, abdominal pain and rushes but were misdiagnosed as enteritis,appendicitis and urticaria. 15 patients（55.6% ）were of lobular pneumonia,with 2-3 lobes involved with focus of infection being at double lobus inferior pulmonis or at the back. 10 patients （37. 0% ） were of interstitial pneumonia,with 3-5 lobes and 2 patients（7. 4% ）were of lobar pneumonia involving 2-3 lobes. Conclusion：The pneumonia deliteseence is related with many facotors. More knowledge and attention can reduce its mortality rate.