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目的观察新生儿宫内肺炎(IP)存在的诊断阴影(漏诊、误诊、迟诊和诊断不一致)及不良影响,并提出防范措施。方法53例宫内肺炎,按入院时间分A组23例和B两组30例,比较其发生入院诊断阴影的情况及其修正和转归。结果A组11例(48%)、B组15例(50%)存在诊断阴影,原因是:①窒息、羊水(胎粪)吸入等表面诊断隐匿了IP诊断;②将早产儿临床表现酷似的肺透明膜病(HMD)与IP混淆;③被最初X线胸片报告误导。临床修正A组5/11例(余为尸检修正),B组15/15例(P<0.01);确诊时间<12h者A组8/23例,B组24/30例(P<0.001);而临床结局A组死亡12例,B组为0(P<0.001)。结论IP易发生诊断阴影,其修正早晚与预后密切相关,需提高认识,加强防范。
Objective To observe the diagnostic shadow (misdiagnosis, misdiagnosis, delayed diagnosis and diagnostic inconsistency) and adverse effects of neonatal intrauterine pneumonia (IP) and to propose preventive measures. Methods 53 patients with intrauterine pneumonia were divided into group A (23 cases) and group B (30 cases). The incidence of the diagnosis of the shadow of the hospitalization were compared, and the correction and prognosis were compared. Results There were 11 cases (48%) in group A and 15 cases (50%) in group B, which were diagnosed as shadow because the surface diagnosis of suffocation and amniotic fluid (meconium aspiration) concealed the diagnosis of IP. ② The clinical manifestations of premature infants were similar Hyaline membrane disease (HMD) and IP confusion; ③ was the first report of misdiagnosed X-ray. There were 5/11 cases in group A (corrected for autopsy), 15/15 cases in group B (P <0.01), 8/23 cases in group A and 24/30 cases in group B (P <0.001) ; While in clinical outcome, 12 patients died in group A and 0 in group B (P <0.001). Conclusions The diagnosis of IP is easy to occur and its correction is closely related to the prognosis. It is necessary to raise awareness and strengthen prevention.