无咳嗽症状小儿早期肺炎的临床诊断及误诊分析

CLINICAL DIAGNOSIS AND MISDIAGNOSIS OF EARLY STAGE PNEUMONIA WITHOUT COUGH IN CHILDREN

目的无咳嗽症状的小儿早期肺炎的临床诊断及误诊研究。方法预先将我科医生分成三组:提醒组和两对照组(提醒组被告知要重视持续或反复高热及呼吸和心率,注意无咳嗽症状的支气管肺炎)。16个月共收集无咳嗽症状的支气管肺炎41例,然后对病例进行诊断及误诊分析。结果提醒组和两对照组在发现无咳嗽症状的支气管肺炎的例数有显著性差异,在首次诊断率、首次误诊率和复诊误诊率中提醒组和两对照组亦有显著性差异。结论要减少无咳嗽症状的支气管肺炎的误诊,儿科医生要重视发热病人,持续或反复高热、呼吸和心率增快的患儿应注意肺炎诊断,早期诊断有赖于及时行胸部影像学检查。

Objective Study of the clinical diagnosis and misdiagnosis of early stage pneumonia without cough in children. Method Twelve of pediatricians were divided into three groups ： one reminded group and two control groups. Reminded group was told to pay extra attention to persistent or recurrent fever, respiratory rate, heart rate and the possibility of the early stage pneumonia without cough （ESPWC）. Forty - one cases of early stage pneumonia without cough （ ESPWG ） were diagnosed in sixteen months. Result 38,321 outpatient attendances were serviced in reminded group and 954 were diagnosed as pneumonia with 40 patients as ESPWC. The control group A serviced 41,537 outpatient attendances and 793 patients were diagnosed as pneumonia with one ESP- WC. The control group B had 52,248 outpatient attendances and 829 patients with pneumonia, but, no ESPWC was diagnosed. The rate of diagnosis of ESPWC was 4.1% of total pneumonia patients in reminded group. Statistics showed the misdiagnosis of ESPWC was obviously high in control groups. Conclusion Pediatricians should pay extra attention to patients with high fever, persistent or recurrent febrile, taehypnea and tachyeardia. The early diagnosis of ESPWC depends on the timely chest imaging.