慢性肾功能衰竭误诊原因分析及其防范措施

摘要

Objective To explore misdiagnosis causes and preventive measures of chronic renal failure (CRF) in order to reduce the misdiagnosis rate.Methods Clinical data of 36 misdiagnosed patients with chronic renal failure in the Affiliated Hospital of Academy of Military Medical Sciences and Academy of Chinese Medical Sciences of Jilin province during January 2004 and December 2009 were retrospectively analyzed.Results In the 36 misdiagnosed patients,9 patients were misdiagnosed as having chronic gastritis,9 patients as having hypertension,7 as having peptic ulcer,4 as having blood loss anemia,4 as having iron deficiency anemia,2 as having sensitization dermatitis and 1 as having pruritus of skin.The misdiagnosis time was 3 months ～4 years.The 36 patients'conditions did not obviously improve and deteriorated little by little after being treated as misdiagnosed disease,and CRF was confirmed by comprehensive analysis of medical history,clinical features and results of medical examinations ; renal function improved in 31 patients to different degrees after active treatment; 4 patients received hemodialysis treatment due to progressions of pathogenetic condition,and the pathogenetic condition was stable after treatment,so the therapy was continued; 1 patient died of myocardial infarction combined with heart failure.Conclusion Chronic renal failure occurs insidiously with complex and different clinical symptoms,so it may affect multiple organs and tissue and may be easily misdiagnosed and missed diagnosis.Clinicians should improve the logical thinking and perform corresponding medical examinations in order to prevent and reduce misdiagnosis rate.%目的 探讨慢性肾功能衰竭(chronic renal failure,CRF)的误诊原因及其防范措施,以降低其误诊率.方法 回顾性分析2004年1月—2009年12月军事医学科学院附属医院及吉林省中医药科学院收治的36例CRF误诊病例的临床资料.结果 36例中误诊为慢性胃炎及高血压病各9例,消化性溃疡7例,失血性贫血及缺铁性贫血各4例,过敏性皮炎2例,皮肤瘙痒症1例.误诊时间3个月～4年.36例按误诊疾病进行相应治疗病情改善均不明显,且渐进性加重,后经综合分析病史、临床表现及医技检查结果确诊为CRF,经积极治疗后31例肾功能均得到不同程度改善；4例因病情进展接受血液透析治疗后病情稳定,并继续维持治疗；1例因心肌梗死合并心力衰竭死亡.结论 CRF起病隐袭,临床表现复杂多样,可累及全身各个脏器和组织,极易漏、误诊.提高临床医生的诊断逻辑思维能力、及时行相关医技检查是防范和减少CRF误诊的关键.