摘要
近年来急性心肌梗死(acute myocardial infarction,AMI)发病率呈升高态势,由于临床表现复杂多变,误漏诊率仍较高。2004—2013年发表在中文医学期刊并经遴选纳入误诊疾病数据库的AMI文献共485篇,累及误诊病例7840例,涉及误诊率文献116篇12 406例,误诊例数2434例,误诊率19.62%。误诊疾病主要为消化系统疾病、循环系统疾病和呼吸系统疾病,误诊范围涉及77种疾病,居前5位的误诊疾病为急性胃肠炎、脑血管病、急性心力衰竭、胆囊胆道疾病和支气管炎。经对全数据库病种检索发现,14个系统102种疾病易误诊为AMI,以循环系统疾病和呼吸系统疾病居多,其中居前5位的循环系统疾病为主动脉夹层、肺栓塞、病毒性心肌炎、早期复极综合征、肥厚型心肌病;呼吸系统疾病以肺栓塞居多。主要误诊原因为经验不足而缺乏对该病的认识。共5412例描述了误诊与疾病转归的关联,其中4683例(86.53%)未因误诊误治造成不良后果,而644例(11.90%)因误诊误治导致死亡。提示临床医师应提高对AMI的认识,重视病史询问和仔细体格检查,及时行特异性医技检查,并仔细鉴别诊断,减少误诊的发生。
In recent years, the incidence rate of acute myocardial infarction （AMI） is showing a rising trend, and the rates of missed diagnosis and misdiagnosis are high due to its complex clinical manifestations. During 2004-2013, reference papers published in Chinese medical journals and selected into the misdiagnosed diseases database of AMI amounted to 485, involving 7840 misdiagnosed cases, among which, there were 2434 misdiagnosed cases marked with a misdiagnosis rate of a total of 12,406 cases in 116 references, so the misdiagnosis rate was 19.62%. Most of the misdiagnosed diseases were digestive system diseases, circulatory system diseases and respiratory system diseases. Misdiagnosis range covered 77 kinds of diseases, among which, the top five misdiagnosed diseases were acute gastroenteritis, eerebrovascular disease, acute heart failure, gallbladder bile duct disease and bronchitis. Through the whole disease database retrieval, we found that 102 kinds of diseases from 14 systems tended to be misdiagnosed as AMI, among which, the majority was circulatory system diseases and respiratory diseases. The top five main circulatory system diseases were aortic dissection, viral myocarditis, hypertrophic cardiomyopathy, early repolarization syndrome and stress cardiomyopathy; while pulmonary embolism was the majority in respiratory system diseases. Misdiagnosis was due to lack of experience, and lack of awareness of the disease. A total of 5412 cases described the association between misdiagnosis and disease outcome, of which, 4683 cases （86.53%） had no adverse conse- quences caused by the disease, and 644 cases （ 11.90% ） died as a result of their errors. Our results indicate that in order to reduce the misdiagnosis and missed diagnosis rates, clinicians should increase the awareness of AMI, attach great importance to thorough disease history inquiry and physical examination, take timely medical examination and pay close attention to differential diagnosis.
出处
《临床误诊误治》
2016年第7期12-19,共8页
Clinical Misdiagnosis & Mistherapy
关键词
心肌梗死
误诊
胃肠炎
脑血管障碍
心力衰竭
肺栓塞
数据库
数据说明
统计
Myocardial infarction
Misdiagnosis
Gastroenteritis
Cerebrovaseular
Heart failure
Pulmonary embolism
Database
Data interpretation, statistical
