高龄老年人自发性乳糜胸误诊为慢性心力衰竭原因分析.pdf

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1、l缶床误诊误治2015年7月第28卷第7期ClinicalMisdiagnosis&Mistheraov．Vo1．28．No．7．Julv2015·9·高龄老年人自发性乳糜胸误诊为慢性心力衰竭原因分析范光德，梅周芳，黄琦慧，钱凌，都勇，施劲东，揭志军【摘要]目的探讨自发性乳糜胸误诊误治原因，提高临床医师对该病的诊治水平。方法对我院收治的l例自发性乳糜胸误诊病例资料进行回顾性分析，并复习相关文献。结果患者81岁，因活动时气促伴双足水肿20d人院。外院诊断为慢性心力衰竭、胸腔积液，行利尿、强心治疗后，患者症状加重。转我院后心脏超声未见明显异常，胸部CT检查示右侧胸腔积液伴

2、右肺下叶膨胀不全。诊断性胸腔穿刺胸腔积液检查示外观呈乳糜样，培养无细菌生长，苏丹Ⅲ染色阳性。完善检查排除相关疾病后确诊为自发性乳糜胸。经多次右侧胸膜腔封闭术，复查胸部CT示胸腔积液消失，随访8个月未见复发。结论胸腔积液患者行诊断性胸腔穿刺胸腔积液检查，对其病因诊断至关重要；胸腔积液苏丹Ⅲ染色有助于鉴别真性和假性乳糜胸。【关键词】乳糜胸；胸腔积液；误诊；心力衰竭；香菇多糖[中国图书资料分类号】R561．7[文献标志码]A[文章编号】1002—3429(2015)07~009—04[DOI]10．3969／j．issn．1002—3429．2015．07．003ADisc

3、ussionofSpontaneousChylothoraxinSenilePatientsMisdiagnosedasChronicHeartFailureFANGuang—de，MEIZhou-fang，HUANGQi—hui，QIANLing，DUYong，SHIJing—dong，JIEZhi—jun(DepartmentofRe—spiratoryDiseases，theFifthPeople~HospitalofShanghai，FudanUniversity，Shanghai200240，China)[Abstract]ObjectiveToanalyz

4、ethecauseofmisdiagnosisofspontaneouschylothoraxtoimprovetreatmentofthisdisease．MethodsAcaseofspontaneouschylothoraxofourhospitalwasretrospectivelyanalyzed，withareviewofliterature．ResultsUponadmission，the81一year—oldfemalepatient，whohadbeendiagnosedaschronicheartfailureandpleuraleffu-sion

5、inalocalhospital，complainedofdyspneaonexertionandfootedemaformorethan20days．Aftertakingdiureticsandcardiotonicdrugs，herconditionbecameworse，andthenshewastrans~edtoourhospita1．Theheartstructureandfunctionwerenotobviouslyabnormalonech0cardiography．ThechestCTscanshowedrightpleura1efusion，w

6、ithincompleteexpansioninthelowerlobeoftherightlung．Thepleuraleffusionwasfoundtobechyli~rmafterthoracentesis．Theexaminationofpleu—raleffusionshowedthatthebacterialculturewasnegativeandthedyeingwithSudan111waspositive．Afterotherrelevantdis—easeswereexcluded，thespontaneouschylothoraxwasdia

7、gnosed．Therefore，thepatientwastreatedwithpleuralclosurefor5timesusinglidocaine0．2g，lentinan3mg，dexamethasone5mgandnormalsaline20m1．ThechestCTscanshowedthatthepleuraleffusionsubsided．Duringeightmonthsoffollow—up，therewasnorelapseofchylothorax．ConclusionForpatientswithpleuraleffu