Ramsay Hunt综合征首诊误诊分析

Analysis of misdiagnosis of Ramsay-Hunt syndrome

目的探讨Ramsay Hunt综合征误诊的原因。方法对64例Ramsay Hunt确诊患者首诊进行回顾性分析。比较耳部疱疹和神经痛阳性率,筛选更敏感的诊断指标;统计误诊疾病种类和比例,提出鉴别诊断的重点;按首诊医师不同分为社区医师组和专科医师组;以首诊症状是否典型分为症状不典型组和症状典型组,并分层分析。结果耳部神经痛阳性率高于疱疹阳性率(P<0.05)。误诊28例,误诊率为43.8%,最易误诊为炎症(67.9%)。社区医师误诊率高于相关专科医师(P<0.05)。症状不典型时社区医师误诊率高于症状典型时(P<0.05);而专科医师误诊率无差别(P>0.05)。结论减少误诊率,可将耳部神经痛作为诊断Ramsay Hunt综合征的主要指标;注意神经痛与炎症疼痛鉴别及同时出现的耳部和面部体征。

Objective To discuss the causes of misdiagnosis of Ramsay-Hunt syndrome. Methods The initial diagnostic data of 64 patients suffering from Ramsay-Hunt syndrome were analyzed retrospectively. The incidences of herpes and neuralgia in auricular region were compared to screen a more sensitive diagnostic parameter. The diseases misdiagnosed and the proportion of misdiagnosis were calculated to conclude the essentials of differential diagnosis. According to the doctor patients initially visited and the initial symptom, all the 64 patients were divided into the community practitioner group and the specialist group, and the typical symptom group and the atypical symptom group respectively. The misdiagnosis rates of different groups were analyzed with Chisquare test. Results The rate of neuralgia in auricular region was higher than that of herpes （ P 〈0. 05）. The number of misdiagnosed cases was 28, and the total misdiagnosis rate was 43.8%. The disease most frequently misdiagnosed was inflammation of auricular region （67. 9%）. The rate of misdiagnosis made by community practitioner group was significantly higher than that by specialist group （ P 〈0.05）. As for the community practitioner, misdiagnosis rate of atypical symptom group was significantly higher than that of typical symptom group （ P 〈0. 05）, and for the specialist, the difference of misdiagnosis rate between the two groups was insignificant （ P 〉0. 05）. Conclusion Neuralgia in auricular region is a sensitive signal to diagnose Ramsay-Hunt syndrome and should be differentiated from inflammatory pain. More attention should be paid to the concurrent auricular and facial signs.