综合性医院肺结核误诊探讨(附100例肺结核误诊分析)

Study on misdiagnosis of pulmonary tuberculosis in general hospital (Analysis of 100 cases of pulmonary tuberculosis misdiagnosed)

目的：提高综合性医院医师对肺结核诊断水平。方法：分析院内外１００例肺结核误诊的临床资料。结果：平均误诊率１７．８％。结论：误诊原因有：①对肺结核的警惕性不高。②对不典型肺结核临床表现缺乏认识。③部分肺结核ｘ线表现不典型。④单凭ｘ线报告做出诊断。⑤不重视痰找抗酸杆菌。减少误诊措施有：①对结核病应有高度警惕性。②提高临床医师对不典型肺结核临床表现认识。③增强对肺结核不典型胸部ｘ线表现的认识。④重视临床治疗后胸片复查。⑤重视痰查结核菌。⑥纤支镜检查可提高痰菌阴性肺结核诊断率。⑦重视病理诊断和临床治疗性诊断。

Objective: To improve the diagnosis standards of physician for pulmonary tuberculosis in general hospital. Methods: The clinical data of 100 pulmonary tuberculosis patients misdiagnosed in and out of our hospital was analyzed. Results: The misdiagnosis rate of pulmonary tuberculosis in general hospital is 17.8%.Conclusions: There are 5 factors affecting the misdiagnosis of pulmonary tuberculosis:①unawareness of pulmonary tuberculosis;②lack of understanding the clinical manifestations of atypical pulmonary tuberculosis;③atypical radiological appearance in part of the patients; ④relying on X-ray report only; and ⑤neglecting the inspecting of mycobacterium in sputum smear.It can reduce the misdiagnosis rate of pulmonary tuberculosis by the following, such as: ①pay more attention to this disease; ②improving the understanding of clinical manifestations in atypical pulmonary tuberculosis; ③realizing more atypical appearance of X-ray; ④comparing the changes of X-ray; ⑤inspecting the mycobacterium tuberculosis in sputum smears as possible; ⑥using fiberoptic bronchoscope availbly;⑦combining the diagnostic pathology with clinical therapy.