基层医院上气道咳嗽综合征误诊原因分析

Causes of Misdiagnosis of Upper Airway Cough Syndrome in Primary Hospital

目的探讨上气道咳嗽综合征(UACS)的临床特点及基层医院误诊原因、防范措施。方法对2021年6—9月收治的曾在基层医院误诊的UACS 8例的临床资料进行回顾性分析。结果本组均以反复咳嗽为主要临床表现,干咳7例,少痰1例。发病初期均曾在外院就诊,误诊为支气管肺炎3例,咳嗽变异性哮喘和感染性咳嗽各2例,慢性咽喉炎1例。于村卫生所误诊7例,社区门诊误诊1例。误诊时间3个月~2年。入我院后经详细问诊、相关检查结合相关诊断标准确诊为UACS(单纯慢性扁桃体炎3例,单纯腺样体肥大2例,慢性扁桃体炎合并腺样体肥大、过敏性鼻炎及慢性鼻窦炎各1例),给予针对性治疗。治疗后随访6~12个月,1例慢性鼻窦炎咳嗽及清嗓症状明显减轻,余7例症状均已消失。结论UACS病因复杂,易误诊。提高对该病认识,及时行相关检查和专科会诊,仔细鉴别诊断,或可减少或避免该病误诊误治。

Objective To investigate the clinical characteristics of upper airway cough syndrome(UACS),causes of misdiagnosis and preventive measures in primary hospitals.Methods The clinical data of 8 cases of UACS who had been misdiagnosed in primary hospitals from June to September 2021 were analyzed retrospectively.Results The main clinical manifestations were repeated cough,and there was dry cough in 7 cases and less sputum in 1 case.In the early stage of the disease,they were treated in other hospitals,including 3 cases that were misdiagnosed as bronchopneumonia,2 cases as cough-variant asthma,2 cases as infectious cough,and 1 case of chronic pharyngitis.Of them,7 cases were misdiagnosed in Yucun health clinic and 1 case in community-based outpatient clinic.Misdiagnosis lasted from 3 months to 2 years.After admission to our hospital,they were diagnosed as UACS based on detailed consultation,relevant examinations and relevant diagnostic criteria,including simple chronic tonsillitis in 3 cases,simple adenoid hypertrophy in 2 cases,chronic tonsillitis combined with adenoid hypertrophy in 1 case,allergic rhinitis in 1 case and chronic sinusitis in 1 case,and targeted treatment was given.After 6 to 12 months of follow-up,the symptoms of cough and throat clearing were significantly relieved in 1 case of chronic sinusitis,and disappeared in the other 7 cases.Conclusion The etiology of UACS is complex,leading to possible misdiagnosis.Improving the awareness of the disease,timely examination,specialist consultation,and careful differential diagnosis may reduce or avoid the misdiagnosis and mismanagement of the disease.