肝性脑病临床误诊分析

Clinical Analysis of Misdiagnosis of Hepatic Encephalopathy

目的 探讨肝性脑病的临床特点及误诊原因、防范措施。方法 回顾性分析2020年4月—2022年11月收治的病初曾误诊的肝性脑病8例的临床资料。结果 本组均有肝硬化病史,有长期酗酒史4例;高蛋白饮食4例,感染3例,腹泻1例;表情淡漠、波动性意识恍惚5例;伴无目的重复动作、徘徊、摸索、抓握东西等精神行为异常表现5例。病初2例行肝功能检查示轻度异常。8例腹部彩色多普勒超声均提示肝硬化,伴腹腔积液5例。误诊为乙醇戒断综合征4例,脑梗死2例,精神分裂症2例。误诊时间8~10 d。8例入我院后经血氨及肝功能等检查皆确诊肝性脑病,予相应治疗4~8 d后病情缓解。结论 临床接诊有慢性肝病史且出现神经精神症状患者时,应警惕肝性脑病;细致查体,详细询问病史及诱因,及早行血氨、肝功能及MRI检查对该病确诊十分重要;对肝功能正常或轻度异常者也不应轻易排除肝性脑病,以避免或减少误诊误治。

Objective To investigate the clinical characteristics,causes of misdiagnosis and preventive measures of hepatic encephalopathy.Methods The clinical data of 8 patients with hepatic encephalopathy who had been misdiagnosed at the initial stage of the disease from April 2020 to November 2022 were analyzed retrospectively.Results All patients had a history of cirrhosis and 4 had a long-term history of alcoholism.There were 4 cases of high protein diet,3 cases of infection and 1 case of diarrhea.There were 5 cases of apathy,confusion in expression,with fluctuating consciousness,and mental and behavioral abnormalities accompanied by aimless repetitive movements,wandering,groping and grasping.At the initial stage of the disease,the liver function test of 2 cases showed mild abnormalities.All 8 cases showed liver cirrhosis with abdominal color Doppler ultrasonography and 5 cases with abdominal fluid.They were misdiagnosed as alcohol withdrawal syndrome in 4 cases,cerebral infarction in 2 cases and schizophrenia in 2 cases.Misdiagnosis lasted 8-10 d.After admission to our hospital,all the 8 patients were diagnosed with hepatic encephalopathy by the examination of menstrual ammonia and liver function,and their condition was relieved after 4-8 days of corresponding treatment.Conclusion Hepatic encephalopathy should be considered in patients with a history of chronic liver disease and neuropsychiatric symptoms.Careful physical examination,detailed medical history and precipitating factors,and early ammonia,liver function and MRI examination are of great importance for the diagnosis of this disease.In order to avoid or reduce misdiagnosis and treatment,hepatic encephalopathy should not be easily excluded in patients with normal liver function or mild abnormalities.