Page 17 - 麻醉与监护论坛2015年第4期
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赵 妍 宋 青 周飞虎 摘要
康红军 潘 亮 刘 辉
目的：探讨血栓性血小板减少性紫癜（Thrombotic Thrombocytopenic
中国人民解放军总医院重症医学科 100853 Purpura TTP）的临床特点及误诊原因分析，以提高患者早期诊断率，生存率并
改善预后。方法：对我院收治的1例T T P的临床资料进行回顾性分析。结果：本
例因“发热、黄疸、酱油尿1天”入院，诊断为药物性肝肾功能损伤，溶血性
贫血。住院期间因意识障碍，呼吸困难转入重症监护病房（I C U）予呼吸机辅助
呼吸，抗感染，营养支持，输注适当血制品及激素冲击等治疗后患者病情有所
好转3d后患者恢复意识，治疗7d拔除气管插管，病情稳定约7天后再次出现溶血
表现，病情恶化，期间多次行多学科会诊，在T T P诊断上仍有一定争议。结论：
TTP的误诊率较高，早期诊断对于改善TTP患者预后有着重要的意义。
关键词：血栓性血小板减少性紫癜；误诊
责任作者与联系方式：赵妍，E-mail: qiqi96219621@163.com
血栓性血小板减少性紫癜误诊思维分析
Thrombotic Thrombocytopenic Purpura TTP Thrombotic
Thrombocytopenic Purpura TTP
Y. Zhao, Q. Song, F.-H. Zhou, H.-J. Kang, L. Pan, H. Liu
Department of ICU, General Hospital of PLA, 100853
Abstract
Objective. To discuss the clinical characteristics and misdiagnosis reason of Thrombotic Thrombocytopenic Purpura (TTP)
in order to improve patients early diagnosis rate, survival rate and improve prognosis.
Methods. A retrospective analysis was performed through the clinical data from 1 case of Chinese PLA hospital diagnosed
as TTP.
Results. The patient was hospitalized because fever, jaundice and soy sauce urine for 1 day. The diagnosis were drug-
induced liver and kidney damage and hemolytic anemia. The patient was transferred into ICU because of the disturbance
of consciousness and dyspnea. Mechanical ventilation, antibiotics therapy, nutrition support, blood products infusion and
hormone treatment were carried out during the period in ICU. The patient restored consciousness after 3 day’s treatment
and was removed endotracheal tube after 7 days. The situation got worse with hemolysis after the next week. The modified
diagnosis of TTP was performed after multidisciplinary consultation which was still a controversial issue.
Conclusion. The misdiagnosis rate of TTP is very high and early diagnosis has great significance to improve the prognosis of TTP.
Key Words: thrombotic thrombocytopenic purpura ; misdiagnosis
Corresponding Author: Y. Zhao, E-mail: qiqi96219621@163.com
血栓性血小板减少性紫癜(TTP)是累及多器官系统的血栓 病例简介：
性微血管病，特点是微血管病性溶血性贫血和血小板减少为 患者，男，58岁，主因“发热、黄疸、酱油色尿1天”
主要特征，常伴有神经精神症状，肾脏损害，发热等症状和 入院，入院前3天患者因自觉风湿疼痛症状加重，在私人诊
体征[1]。由于该病发病率相对较低，临床表现和实验室检查 所肌注中成药物风湿宁治疗。入院前一天因感冒，发热于
缺乏特异性,加之T T P典型五联征：血小板减少、微血管病溶 卫生所输注头孢呋辛、利巴韦林治疗后体温一度升至41度，
血性贫血、发热、神经精神症状、肾功能损害[2][3]，仅见于 后予尼美舒利，激素治疗，患者出现全身大汗，血压下降
少数患者(<40%)，故对血液科临床医生而言，TTP仍是较难诊 至85/53m m H g，急诊收入我院急诊病房治疗。入院时患者意
断的一种疾病。 识清楚，烦躁，体检:体温36.4℃，贫血貌，皮肤黄染并可
见散在瘀点、瘀斑；实验室检查提示：血红蛋白：62g/L，
一、临床资料 红细胞2.26×109/L；血小板25×109/L；网织红细胞计数
为2.5%，末梢血涂片示:红细胞明显大小不均，可见有核红
以海南分院重症医学科2012年11月收治的1例患者为例。
Laboratory RanedviCewlinaicnadl CInMvEesLtiegcattuioren 40 FAM 2015 Jan/Feb Vol.22 Issue 1
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