误诊为肺炎的四例新生儿疾病分析

Analysis of Neonatal Disease of 4 Cases Misdiagnosed as Pneumonia

目的分析误诊为新生儿肺炎的相关原因,以降低误诊率,提高新生儿疾病的诊疗水平。方法回顾性分析4例误诊为新生儿肺炎的临床资料。结果1例因呛奶后呼吸困难、皮肤发绀3 h入院,1例因呼吸困难、口唇发绀6 d入院,1例因口吐白色分泌物、呼吸困难1.5 d入院,1例因呼吸困难、拒奶2 d入院。4例均误诊为新生儿肺炎,给予对症处理后症状未见好转,误诊时间1~3(1.89±0.32)d。后完善相关检查或进一步询问病史,1例确诊为新生儿右侧乳糜胸,予以抗感染、增强免疫功能、胸腔穿刺抽液及对症支持治疗后病情好转出院;1例确诊为先天性会厌囊肿,行会厌囊肿切除术及对症治疗后痊愈出院;2例确诊为有机磷中毒,予阿托品、解磷定、利尿、营养支持等治疗后好转出院。结论新生儿肺炎的典型症状为呼吸困难、口唇发绀,但并不是其独有症状,因此,对于出现呼吸困难、口唇发绀的新生儿应进行全面综合的检查,不能仅依赖临床症状和体征进行诊断,同时临床医师对可能引起新生儿呼吸困难的相关疾病也应进行一定的了解,及时予以对症治疗,以降低误诊率,改善预后。

Objective To analyze the related causes of misdiagnosis as neonatal pneumonia,in order to reduce the rate of misdiagnosis and improve the clinical diagnosis and treatment for neonatal diseases.Methods The clinical data of 4 cases misdiagnosed as neonatal pneumonia were retrospectively analyzed.Results One case was admitted to the hospital for dyspnea and cyanosis for milk choking for 3h,1 case was admitted due to dyspnea and cyanosis of lips for 6 days,1 case was admitted due to white secretion at the mouth and dyspnea for 1.5 days,and 1 case was admitted for dyspnea and milk rejection for 2 days.All 4 cases were misdiagnosed as neonatal pneumonia.After symptomatic treatment,the symptoms did not improve.The duration of misdiagnosis was 1-3(1.89±0.32)days.After improving related examinations or further inquiry about the medical history,1 patient was diagnosed with neonatal chylothorax on the right side,and was given anti-inflammatory treatment,enhancement of immune function,thoracentesis,and symptomatic supportive treatment.The patient was discharged from hospital after the condition was improved.One patient was diagnosed with congenital epiglottic cyst,and was discharged from hospital after epiglottic cyst resection and symptomatic treatment.Two patients were diagnosed with organophosphorus intoxication,and were cured and discharged after treatment with atropine,pralidoxime iodide,diuretic and nutritional support.Conclusion The typical symptoms of neonatal pneumonia are dyspnea and cyanosis of lips,which,however,are not unique symptoms.Therefore,for the newborns with dyspnea and cyanosis of lips,comprehensive examination should be carried out.It should not rely solely on its clinical manifestations and symptoms to make diagnosis.The clinician should understand the knowledge of the diseases associated with neonatal dyspnea,and give timely symptomatic treatment,so as to further reduce the rate of misdiagnosis and improve the prognosis.