贵州省职业性尘肺病诊断差异问题分析  

Analysis of Diagnostic Disparities in Occupational Pneumoconiosis in Guizhou Province

作　　者：曾艳 卢娇娇 杨平 黎东霞 胡兴东 敖云霞 张顺 ZENG Yan;LU Jiao-jiao;YANG Ping;LI Dong-xia;HU Xing-dong;AO Yun-xia;ZHANG Shun(The Third People's Hospital of Guizhou,Guizhou Occupational Disease Prevention and Treatment Hospital,Guiyang,550008,Guizhou)

机构地区：[1]贵州省第三人民医院贵州省职业病防治院,贵州贵阳550008

出　　处：《黔南民族医专学报》2024年第4期421-425,共5页Journal of Qiannan Medical College for Nationalities

基　　金：贵州省卫健委课题(gzwkj2021-391)。

摘　　要：目的:分析我省不同机构及职称医师职业性尘肺病诊断差异的原因及漏诊误诊的影响因素,以期为减少我省的尘肺漏诊误诊提供新的思路和见解。方法:随机抽取150名参加我省职业病诊断培训、考核培训及我院进修及本院中级以下职称医师职业性尘肺个案作为研究对象。结果:从事诊断工作年限越长的诊断医师肺区密集度划分更加准确;CT复核比未经CT复核的准确率高,OR=0.41,95%CI(0.25-0.66),P<0.001;参加职业考核培训比不参加职业培训具有更高的诊断准确率,OR=0.29,95%CI(0.16,0.54),P<0.001;病程长比病程短具有更高的诊断准确OR=0.64,95%CI(0.45,0.90),P=0.012;患者年龄对诊断结果无显著性影响,OR=0.92,95%CI(0.63,1.34),P=0.672。患者BMI对诊断结果无显著性影响OR=1.13,95%CI(0.73~1.74),P=0.585。结论:高级职称、CT复核、专科考核培训、病程长是减少漏诊及误诊的保护因素。年资低、未使用CT复核、未参加专科培训考核、病程短是造成漏诊误诊的危险因素。应该强化尘肺病诊治职业化培训,提高诊断医师的资历,并强化CT复核及专家审核步骤,提高准确率,减少纠纷及漏诊误诊。Objective:To analyze the reasons for diagnostic differences in occupational pneumoconiosis among institutions and physicians of different professional ranks in our province,as well as to explore factors contributing to missed and misdiagnoses,providing new insights and suggestions for reducing such occurrences.Methods:A total of 150 cases diagnosed by physicians who participated in provincial occupational disease diagnosis training,assessment training,visiting physicians at our hospital,and in-house physicians with intermediate or lower titles were randomly selected as research subjects.Results:Diagnostic accuracy in lung region density classification improved with longer tenure in diagnostic work.CT verification was more accurate than non-CT verified diagnoses,with an odds ratio(OR)of 0.41,95%confidence interval(CI)[0.25-0.66],P<0.001.Participation in occupational assessment training resulted in higher diagnostic accuracy compared to non-participation,OR=0.29,95%CI[0.16,0.54],P<0.001.Longer disease duration was associated with higher diagnostic accuracy,OR=0.64,95%CI[0.45,0.90],P=0.012.Patient age did not significantly impact diagnostic results,OR=0.92,95%CI[0.63,1.34],P=0.672.Similarly,patient BMI had no significant effect on diagnostic outcomes,OR=1.13,95%CI[0.73,1.74],P=0.585.Conclusion:Senior professional titles,CT verification,specialized assessment training,and longer disease duration are protective factors against missed and misdiagnoses.Lower professional seniority,lack of CT verification,absence from specialized training assessments,and shorter disease duration are risk factors leading to diagnostic errors.It is recommended to strengthen specialized training for the diagnosis and treatment of pneumoconiosis,enhance the qualifications of diagnosing physicians,and reinforce steps for CT verification and expert review to improve accuracy and reduce disputes and diagnostic errors.

关 键 词：职业病诊断 职业性尘肺 读片差异 影响因素 

分 类 号：R135.2[医药卫生—劳动卫生]