哑型二尖瓣狭窄13例误诊讨论

Discussion on Misdiagnosis of 13 Patients with Silent Mitral Stenosis(SMS)

目的分析哑型二尖瓣狭窄(silent mitral stenosis,SMS)的误诊原因,探讨其临床特点及诊治体会。方法对我院1958年2月—2008年2月收治并首诊误诊的SMS 13例的临床资料进行回顾性分析。结果本组心功能Ⅲ级10例,Ⅳ级3例;误诊为冠心病7例,肺心病5例,病毒性心肌炎1例。后经心电图、心脏超声检查结合临床表现诊断为SMS,确诊后均予抗感染、抗风湿及抗心力衰竭等治疗,其中3例同时予手术治疗,均好转出院。结论 SMS起病隐匿,临床表现无特异性且缺乏提示二尖瓣狭窄的心尖区舒张期杂音,易误诊。临床应提高对本病的认识和警惕性,充分利用医技检查,特别是心脏超声,可提高本病的正确诊断率。

Objective To analyze the cause of misdiagnosis of SMS and explore the clinical characteristics and experience in applying treatment. Methods Clinical data of 13 patients with SMS misdiagnosed at the first visit during February 1958 and February ：2008 were retrospectively analyzed. Results The group consisted of 10 patients with grade Ⅲ cardiac function, 3 patients with grade Ⅳ cardiac function; misdiagnosed diseases consisted of 7 patients with coronary heart disease, 5 patients with pulmonary heart disease and 1 patient with viral myocarditis. The patients were diagnosed as having SMS by the electrocardiogram, echocardiogram and clinical manifestation, who were treated with the anti-infection, anti-rheumatism and anti-heart failure procedures after diagnosis was made. 3 patients underwent operations simultaneously and recovered well upon discharge. Conclusion SMS tends to be misdiagnosed because of hidden onset, indistinctive clinical features, and lack of hint in left ventricular apical reversed murmurs which might prompt mitral stenosis. To improve the correct ratio of diagnosis we should raise awareness and vigilance against SMS, and make full use of medical examinations, especially echocardiography.