述评:急性中毒的经验性诊断思维的应用

Experiential Thoughts in Diagnosis of Acute Intoxication

早期诊断、治疗,是降低急性中毒病死率的关键。急性中毒的诊断不同于通常意义上的病因诊断、病理生理学或病理解剖学诊断等,其更多的是依据临床经验进行判断。当患者有明显的毒物接触史和相应的临床表现时,一般可作出诊断。但当毒物接触史不明时容易发生漏误诊。急性中毒的经验性诊断就是按照急性中毒的诊断流程,询问是否有突然的精神刺激,根据患者的靶器官损害的临床表现、结合特有的和一般器官功能的实验室检查及诊断性治疗等综合分析,迅速判断患者是否中毒,推断毒物种类,评估中毒程度,达到减少漏诊、误诊,提高诊断正确性的目的。

It is the key to reduce fatality rate of acute intoxication by timely diagnosis and therapy. Confirmation of acute intoxication is different from common diagnosis such as etiological diagnosis, morbid physiology and anatomopathology diagnoses, etc. It depends more on clinical experiences. The acute intoxication can be confirmed when patients have obvious toxic exposure history and clinical corresponding manifestations, but it may be misdiagnosed or missed diagnosis when patients did not have obvious toxic exposure history. The experiential diagnostic method of acute intoxication is to ask if patients have sudden emotional disturb- ance, analyze diagnostic therapy and special laboratory examinations combined with common organic functions, which are based on clinical impaired manifestation of patients＇target organs to promptly diagnose if patients are suffering from intoxication, and evaluate poison types and poisoning degrees. By this method, clinicians may increase accuracy of diagnosis and reduce misdiagnosis and missed diagnosis rates.