老年肺结核误诊17例临床剖析.docVIP

老年肺结核误诊17例临床剖析 　　摘要:目的 探讨老年肺结核的临床特点及易误诊的原因。方法 统计我院2001年1月~2005年12月间内科住院病人中60岁以上老年人肺结核被误诊为其他疾病的患者，并对其进行分析和总结。结果 几乎每例病人均合并1种以上基础疾病，其中：9例误诊为肺炎，1例误诊为白血病，2例误诊为肺癌，1例误诊为脑血管意外，1例误诊为肺脓肿，3例误诊为慢性支气管炎急性发作。结论 老年人免疫力低下、结核中毒症状不明显、起病隐匿，加之老年人多合并其他并存病，故极易误诊。且老年人肺部表现不典型，易行成空洞，故痰查结核杆菌阳性率高，痰菌检查是肺结核诊断的依据。PPD试验阳性率低，但对PPD阴性的老年人进行动态观察具有重要意义。? 　　关键词 肺结核 误诊 老年肺结核?? 　　 　　Misdiagnostic Analysis of 17 Cases of Senile Pulmonary Tuberculosis.Guo-Li.The first peoples 　　hospital of LiangShan province , XiChang 615000, SiChuan, China.?? 　　【Abstract】Objective To explore the clinical feature and misdiagnosis cause of senile pulmonary Tuberculosis.Methods To survey the medical chronic inpatiens for tuberculosis misdiagnosed as other diseases which were above 60 years old in our hospital from 2001 January to 2005 December and we have taken an analysis and summary.Results almost each case was complicated with underlying disease. Among the total , 9 cases were misdiagnosed as pneumonia, 1 case was misdiagnosed as leukemia ,2 cases were misdiagnosed as lung cancer , 1 case was misdiagnosed as cerebral accident, 1 case was misdiagnosed as lung abscess,3 cases were misdiagnosed as acute episode of chronic bronchitis.Conclusion The senile pulmonary tuberculosis was easy to be misdiagnosed because of hypoimmunity of aged people ,not obvious symptomof the tuberculosis toxic, and the onset of the disease is insidious.The clinical features of aged people were not typical . It is easy to form pulmonary cavity. Positive rate of Mycobacterium tuberculosis test is high, bacteriological examination is an important basis of diagnosis. Even if the positive rates of PPD test is low, the dynamic observation on old-aged patient with negative PPD could be of great important. ? 　　【Key words】 pulmonary tuberculosis; misdiagnosis; senile pulmonary Tuberculosis ?? 　　 　　肺结核病是由结核杆菌引起的慢性呼吸道传染病，结核病长期威胁着人类的健康。随着社会的进步、医疗条件的改善，人均寿命延长，人口老龄化，老年人肺结核病已成为倍受关注的课题。近年来，我国老年肺结核发病率呈明显上升趋势。由于老年人肺结核临床症状不典型、误诊率高、疗效差，有时还可引起家庭、集居老年人群的爆发流行。因