31例误诊哮喘原因分析

目的通过对中央气道不全性梗阻和支气管结核、术后痰栓形成误诊为支气管哮喘的分析，探讨误诊原因及正确诊断的方法。方法对误诊为支气管哮喘的3l例患者的临床资料进行分析。结果临床特征以刺激性咳嗽为主，其次为活动后胸闷、气促，肺部闻及哮鸣音，胸部影像学多无特征性改变或极易漏诊，支气管舒张试验阳性率低，诊断前缺乏气管镜及病理检查，均误诊为支气管哮喘。结论中央气道不全梗阻性病变或炎性病变包括支气管结核、术后痰栓形成时原发疾病症状不典型，肺部影像学检查无异常表现或极易漏诊，故该类以表现为咳嗽、喘息、活动后胸闷，进而出现严重呼吸困难的患者常被误诊为支气管哮喘，延误诊治。支气管镜及病理检查再结合肺CT是鉴别诊断的重要方法。

Analysis of 31 Cases of Misdiagnosis of Asthma

Objective To study the cause of misdiagnosis of bronchial asthma to get a way of correct diag- nosis by analyzing the incomplete block of central air way and the misdiagnosis of bronchial asthma caused by bronchial tuberculosis and sputum bolt after operation. Method We made an analysis on the clinical data of 31 patients,who were misdiagnosed as bronchial asthma.Result For those which are characterized mainly as irritable cough, secondly as chest distress,shortness of breath and wheezing in lung after exercises,mostly there is no charac- teristic change on chest radiogram or easily got a missed diagnosis.The positive rate of bronchial dilation test is quite low and there is a lack of bronchoscope and pathological examination before diagnosis.All those are misdiagnosed as bronchial asthma.Conclusion The patients who get pathological changes caused by the incomplete block of central air way or inflammatory changes including bronchial tuberculosis,the atypical symptom of etiology which caused sputum bolt after operation,no abnormal symptom on lung radiogram or easily got missed diagnosis which is manifested as cough,wheezing, chest distress after exercises and furthermore with seriously hard breathing, are often misdiagnosed to get bronchial asthma, delaying the normal diagnosis.At this point, bronchoscope and patho- logical examination,together with lung CT is an important way of differential diagnosis of bronchial asthma.