CAJ | 학술논문

蛛网膜下腔出血( subarachnoid hemorrhage, SAH)是临床常见脑血管疾病。虽然临床诊疗技术不断发展,但本病误诊率仍居高不下。2005—2012年发表在中文医学期刊并经遴选纳入误诊疾病数据库的SAH文献共118篇,纳入误诊病例2085例,平均误诊率20.43%；误诊范围涉及80种疾病,其中前3位误诊疾病为后循环缺血、各种头痛和高血压病。对误诊疾病数据库中近3000种疾病的误诊范围检索发现,共29种疾病易误诊为SAH,居前3位的是颅内静脉窦血栓形成、低颅压综合征和脑出血。2085例误诊病例首位误诊原因为接诊医师经验不足,缺乏对该病的认识,占总误诊原因的24.23%,其中133例(6.38%)造成1级误诊后果(死亡或遗留后遗症),21例(1.01%)造成2级误诊后果(因误诊而导致病程迁延或导致不必要的手术),1225例(58.75%)造成3级误诊后果(未因误诊造成明显不良后果),706例(33.86%)失访或文献未交代预后。提示临床医师应加强对SAH的认识,详细询问病史及细致全面查体,及时合理选择腰椎穿刺脑脊液、头颅CT检查,早诊断并给予有效的针对性治疗,降低病死率。
주망막하강출혈( subarachnoid hemorrhage, SAH)시림상상견뇌혈관질병。수연림상진료기술불단발전,단본병오진솔잉거고불하。2005—2012년발표재중문의학기간병경린선납입오진질병수거고적SAH문헌공118편,납입오진병례2085례,평균오진솔20.43%；오진범위섭급80충질병,기중전3위오진질병위후순배결혈、각충두통화고혈압병。대오진질병수거고중근3000충질병적오진범위검색발현,공29충질병역오진위SAH,거전3위적시로내정맥두혈전형성、저로압종합정화뇌출혈。2085례오진병례수위오진원인위접진의사경험불족,결핍대해병적인식,점총오진원인적24.23%,기중133례(6.38%)조성1급오진후과(사망혹유류후유증),21례(1.01%)조성2급오진후과(인오진이도치병정천연혹도치불필요적수술),1225례(58.75%)조성3급오진후과(미인오진조성명현불량후과),706례(33.86%)실방혹문헌미교대예후。제시림상의사응가강대SAH적인식,상세순문병사급세치전면사체,급시합리선택요추천자뇌척액、두로CT검사,조진단병급여유효적침대성치료,강저병사솔。
Subarachnoid hemorrhage ( SAH) is a common type of cerebrovascular disease. Although clinically diag-nostic technique develops quickly, the misdiagnosis rate of SAH is still high. 118 literatures of misdiagnosis SAH were select-ed from enrolled misdiagnosis disease database, published in Chinese medical journals during 2005 to 2012. The enrolled mis-diagnosed cases were 2085 patients and the average misdiagnosis rate was 20. 43%. The misdiagnosis diseases involved 80 kinds of diseases. Among them, the most misdiagnosed cases were posterior circulation ischemia, headache and hypertension. 29 kinds of diseases from 162 literatures including 394 patients were found to be frequently misdiagnosed as SAH after search-ing full disease database. The top three diseases were venous sinus thrombosis, intracranial hypotension syndrome and cerebral hemorrhage. In the 2085 misdiagnosed cases, the leading misdiagnosis cause was lack of clinical experience and lack of awareness of the disease on the physicians' part, accounting for 24. 23%, including 133 cases (6. 38%) developed grade Ⅰmisdiagnosis result (death or obvious sequela), 21 cases (1. 01%) gradeⅡmisdiagnosis result (prolonged disease course or unnecessary surgery), 1225 cases (58. 75%) grade Ⅲ misdiagnosis results (no obvious adverse Sequa), and 706 cases (33. 86%) were unclear due to lost follow up or unexplained prognosis of literatures. The results imply that clinical physicians should enrich the knowledge of SAH. The detailed history and careful physical examination, timely and reasonable lumbar puncture, and CT examination are essential for early diagnosis and treatment so as to reduce mortality rate.