急诊眩晕患者头颅CT临床实用性初步研究  

Preliminary study on clinical utility of head CT in emergency vertigo patients

作　　者：潘满冬[1] 蔺际[1] 张民伟[1] 

机构地区：[1]厦门大学附属第一医院急诊部,361003

出　　处：《中国实用医药》2017年第21期39-41,共3页China Practical Medicine

摘　　要：目的调查急诊眩晕患者头颅CT临床实用价值。方法收集以头晕、眩晕或行走不稳为主诉的1085例急诊眩晕患者资料,主要包括个人基本信息、就诊方式、头颅CT和头颅磁共振成像(MRI)检查、急诊滞留时间及医疗费用等,并进行相关统计分析。结果 1085例急诊眩晕患者中,有358例完成头颅CT检查,CT检查使用率33.0%。从接受CT检查及未接受CT检查的患者临床资料来看,老年患者、救护车送入患者,以及既往有脑卒中、高血压、糖尿病病史的患者容易被安排接受CT检查(P<0.05);且与未接受CT检查患者的急诊滞留时间(67.4±9.7)min、医疗费用(263.4±67.8)元比较,接受CT检查患者的急诊滞留时间为(96.5±12.7)min,增加43.2%,医疗费用为(535.8±78.4)元,增加103.4%,差异均具有统计学意义(P<0.05)。358例完成头颅CT检查的患者中,有14例具有临床意义的阳性病灶,阳性率仅为3.9%。有112例经CT检查呈阴性的急诊眩晕患者在急诊科治疗后症状无缓解,而后接受住院治疗并进行头颅MRI检查,结果证实其中15例患者存在新发脑梗死灶。结论在急诊眩晕患者的临床诊断中,头颅CT具有一定的辅助诊断价值但十分有限,眩晕的确诊更应注重于患者的病史及详细的床边临床检查。Objective To investigate the clinical utility of head CT in emergency vertigo patients. Methods The data of 1085 emergency vertigo patients, with main suit of dizziness, vertigo or walking instability, were collected. It mainly included personal basic information, treatment methods, head CT and head magnetic resonance imaging （MRI）, emergency stay time and medical expenses, and related statistical analysis was performed. Results Among 1085 emergency vertigo patients, there were 358 cases had complete head CT examination, with CT examination utilization rate as 33.0%. According to clinical data of patients with or without CT examination, elderly patients, ambulance sending patients, and patients with previous stroke, hypertension and diabetes were easily assigned to CT examination （P〈0.05）. Patients with CT examination had statistically significant difference in emergency stay time as （96.5 ＋ -12.7） min, with an increase of 43.2%, medical expenses as （535.8 ：t： 78.4） yuan, with an increase of 103.4%, comparing with （67.4 ＋ 9.7） min and （263.4 ＋ 67.8） yuan in patients without CT examination （P〈0.05）. Among 358 patients with complete head CT examination, there were 14 clinical significance of positive lesions, and the positive rate was only 3.9%. There were 112 cases of negative emergency vertigo patients by CT examination and no symptoms relieved after emergency treatment. Then they underwent hospitalization for head MRI examination, and the results showed that 15 patients had newly developed cerebral infarction. Conclusion In clinical diagnosis of emergency vertigo patients, head CT shows certain certain but very limited auxiliary diagnostic value. The diagnosis of vertigo should pay more attention to the patient＇s medical history and detailed bedside clinical examination.

关 键 词：眩晕 CT 诊断价值 

分 类 号：R741[医药卫生—神经病学与精神病学]