上海市1998-1999年新登记老年肺结核病人误诊情况分析  

THE CONDITION OF MISDIAGNOSIS IN THE ELDERLY NEW-REGISTERED PULMONARY TUBERCULOSIS FROM 1998 TO 1999 IN SHANGHAI

作　　者：李永祥[1] 沈鑫[1] 梅建[1] 沈梅[1] 夏珍[1] 

机构地区：[1]上海市疾病预防控制中心,200336

出　　处：《老年医学与保健》2003年第3期161-164,共4页Geriatrics & Health Care

摘　　要：目的分析上海市新登记老年肺结核病人中误诊(过诊)状况及探讨减少误诊的途径。方法研究对象为1998-1999年新登记老年肺结核病人取消登记原因为误诊的病例,分析被误诊的疾病种类、造成误诊的诊疗单位分布,延误诊断和抗痨治疗时间,误诊对结核病控制的影响程度。结果老龄组误诊率为6.02%,高龄组为6.61%。被误诊的疾病种类前三位是肺癌、肺炎及非活动性肺结核。老龄组与高龄组在结核病和误诊疾病诊断特征上差异不大。病人自身延误诊断时间老龄组71.66天,高龄组14.77天;医源性延误老龄组是27.93天,高龄组16.77天;诊断性抗痨时间老龄组73.20天,高龄组66.00天。结论在肺结核防治过程中正确诊断是一个发现和治愈肺结核病人重要的前提,主要是提高痰检阴性肺结核病人的诊断正确性,菌阴病人的诊断有待开发类似菌阳病人痰检涂片和培养找抗酸杆菌的诊断“金”标准的技术和方法。在目前组织和提高市和区县结核病防治化疗例会制度,各科医生集体对疑难病例的诊断,不失为减少误诊的必要措施。Objects To analyze the condition of misdiagn osis(over -diagnosis)in the elderly new -registered pul-monary tuberculosis in Shanghai and to discuss the ways of reducing misdi agnosis.Methods All the elderly new -registered tuberculosis(TB)cases who were withdrawed because of being misdiagnosed from 1998to 1999in Shanghai were included in the analysis.Analyze the kinds of di seases misdiagnosed,the distribut ion of hospital causing misdiagnosing,the time of di-agnosis -delay and anti -tuberculosis treatment,and how misdiagnosis e ffected on tuberculosis control.Results The mis-diagnosis rate was 6.02%for elderly cases(for senility,the rate was 6.61%).The time of patient -delay was 24.63days.The time of doctor -delay included:f irst,the time of diagnosed as PTB was24.62days;second,the time of withd rawed was74.08days.Conclusions Diagnosis correctly is important pr emise that find and cure pulmonary tu berculosis,especially for the sputum -negative patients.It is necessary to develop gold standard t o diagnose sputum -negative tubercu losis.It is the essential measure to Organize and im prove the regular meeting of tubercu losis prevention and chemotherapy.The difficult cases should be diagnosed by doctors colle cted of several departments.[

关 键 词：结核 肺 误诊 老年人 

分 类 号：R521[医药卫生—内科学]