隐匿性自发性颅内出血误诊因素分析  

Analysis on Misdiagnosis Factors of Occult Spontaneous Intracranial Hemorrhage

作　　者：刘宏利[1] 牛建荣 刘思齐[1] 陈永亮[1] 张永生[1] 白丽[1] 

机构地区：[1]空军总医院急诊部 [2]空军95147部队医院

出　　处：《河北医学》2012年第8期1078-1081,共4页Hebei Medicine

摘　　要：目的:为提高临床医师对隐匿性自发性颅内出血病症的认识,做到早诊断早治疗,减少误诊误治。方法:总结327例隐匿性自发性颅内出血病例的临床资料,并将初诊时误诊病例与明确诊断病例的资料进行比较,分析导致隐匿性自发性颅内出血初诊时误诊的可能因素。结果:①隐匿性自发性颅内出血仅表现为可忍受的持续性头痛,很少有特异性的临床症状;②硬膜下出血最容易被误诊,其误诊病例占总误诊病例的60.7%;③出血量少,发病至就诊时间长,容易导致误诊;④硬膜下出血组的误诊率最高(85.37%),然后依次为外囊出血组(71.70%)、蛛网膜下腔出血组(21.43%)及脑叶出血组(19.26%);⑤高级职称医师初诊时对该病的误诊率明显低于非高级职称医师(X2=43.27,P<0.01)。结论:隐匿性自发性颅内出血出血量相对较少、症状轻微,患者及家属延误就医,加之医师对其认识不足、忽视头颅CT检查可能是其主要误诊因素。Objective： To improve the cognition of clinician to the occult orrhage , to achieve early diagnosis and treatment and reduce error diagnosis spontaneous intracranial hem-and treatment. Method： We summarized the clinical data of 327 occult spontaneous intracranial hemorrhage patients, and compared the data of cases which were misdiagnosed in initial visit with that of cases which were diagnosed correctly in ini-tial visit, in order to analyze possible factors which lead to misdiagnosis of the occult spontaneous intracranial hemorrhage in initial visit. Result： ①In addition to persistent headache which could be tolerated, the occult spontaneous intracranial hemorrhage has almost no other special clinical symptoms. ②Subdural hemorrhage was the most easily misdiagnosed. The misdiagnosed subdural hemorrhage cases account for 60.7% of the to-tal misdiagnosed cases. ③Less bleeding and delayed treatment prone to lead to misdiagnosis. ④The misdi-agnosed rate of subdural hemorrhage （ 85.37% ） was the highest, and then in decreasing order was as fol-lows： external capsule hemorrhage（71.70% ） , subarachnoid hemorrhage121.43% ） , cerebral lobar hemor-rhage 119.26% ）. ⑤The misdiagnosis rate of senior physicians was obviously lower than that of junior physi-cians（ X2 =43.27 ,P〈0.01 ）. Conclusion： It may be main misdiagnosed factors of occult spontaneous in-tracranial hemorrhage for the amount of bleeding to be relatively small, the clinical symptoms to be mild, pa- tients and their families to delay medical treatment, combined with the physicians to lack knowledge of the disease and ignore the head CT examination.

关 键 词：隐匿性出血 颅内出血 误诊 

分 类 号：R651.1[医药卫生—外科学]