急性视网膜坏死综合征误诊原因分析  

Analysis of the causes of misdiagnosis of acute retinal necrosis syndrome and our measure in preventing it

作　　者：吴红云[1] 易长贤[2] 杨莎莎[2] 练苹[2] 

机构地区：[1]江西省赣州市人民医院眼科,赣州341000 [2]中山大学中山眼科中心眼底病中心,广州510060

出　　处：《中国实用眼科杂志》2013年第12期1649-1652,共4页Chinese Journal of Practical Ophthalmology

摘　　要：目的分析急性视网膜坏死综合征（Acute retinal necrosis syndrom，ARN）误诊的原因，探讨防止误诊的对策。方法收集2006年5月至2012年5月在中山大学中山眼科中心确诊并住院治疗81例（93只眼）ARN患者的临床病史资料，并对临床资料进行回顾性分析。结果81例患者发病至初诊时间1—21天不等，平均7．03天，发病至正确诊断为ARN的时间为5-280天不等，平均31．11天；初次就诊确诊病例7例7只眼，多次就诊后确诊病例74例86只眼，误诊率91．36％；74例误诊病例中1次误诊后确诊病例22例，占29．73％，2次误诊后确诊病例35例，占47．30％，3次及以上误诊后确诊病例17例，占22．97％；86只误诊眼中误诊为葡萄膜炎55只眼占63．95％，其中明确误诊为虹膜睫状体炎的27只眼占31，40％，误诊为其他无明确类型的葡萄膜炎28只眼占32．56％；另外误诊为结膜炎的15只眼占17．44％，误诊为青光眼的3只眼占3．49％，误诊为视网膜炎、视网膜静脉炎、视网膜动脉阻塞及视网膜出血的共13只眼占15．12％。结论ARN是高误诊率高、致盲率的眼部疾病，加强各级医务人员对ARN的认识，提高诊疗水平，刻不容缓。Objective To analyze the causes of misdiagnosis of acute retinal necrosis syndrome （ARN）, and possible critical points in preventing misdiagnosis. Methods Clinical data of 81 cases （93 eyes） in-patients with ARN from May 2006 to May 2012 in Zhongshan Ophthalmic Center, Sun Yat-sen University were retrospectively analyzed. Results The average time of first visit after appearance of ocular symptoms was 7.03 days （1 to 21 days）, 86 eyes （91.36%） was misdiagnosed in total. There were only 7 eyes that were correctly diagnosed at initial ophthalmic consultation. It took 31.11 days （ranging from 5 to 280 days） to reach the correct diagnose. Among the misdiagnosed eyes, 22 eyes （29.73%） experienced one time misdiagnosis, 35 eyes （47.3%） twice and 17 eyes （22.97%） had correctly diagnosis after three or even more time of ophthalmic examinations. Of the 86 misdiagnosed eye, 55 eyes （63.95%） was labeled as uveitis, 27 eyes （31.40.%） as iridocyclitis, 28 eyes （32.55%） as other without explicit type of uveitis. Fifteen eyes （17.44%） were as conjunctivitis and 3 eyes （3.49%） as glaucoma and 13 eyes （15.12%） as others such as retinitis, Eales disease, retinal artery occlusion and retinal hemorrhage. Conclusions ARN is a easily misdiagnosed severe eye diseases. Ophthalmic professional have be alert when come across various uveitis and retinal diseases.

关 键 词：急性视网膜坏死综合征 诊断 误诊 对策 

分 类 号：R774.1[医药卫生—眼科]