广西壮族自治区恙虫病191例误诊原因分析

摘要

目的：对广西壮族自治区近年恙虫病误诊概况进行分析，为进一步提高恙虫病诊治水平提供依据。方法对2009年1月—2013年12月广西医科大学第一附属医院及柳州市人民医院确诊的恙虫病患者临床资料进行整理和数据统计分析。结果两所医院5年间共确诊恙虫病216例，其中误诊191例(88.43%)，均为外院误诊。临床表现复杂多样，主要症状有发热、呼吸系统症状、消化系统症状、头痛、皮疹及皮肤焦痂等。主要误诊疾病为不明原因发热(74．87%)、肺炎(9.42%)、上呼吸道感染(6.81%)等。误诊医院为乡镇卫生院67例(35.08%)，县级医院64例(33．51%)，私人诊所30例(15.71%)，市级医院26例(13.61%)，省级医院4例(2.09%)。首诊科室主要为内科和急诊科。误诊导致患者并发多器官和(或)系统损害125例(65.45%)，其中16例(8.38%)救治无效死亡。结论恙虫病误诊率近年呈上升趋势，误诊医院主要集中在县级及以下医疗机构，应有针对性地加强县、乡级医疗机构医务人员恙虫病诊治相关知识的培训，以降低恙虫病的误诊率。%Objective To investigate the misdiagnosis of scrub typhus in Guangxi Zhuang Autonomous Region in order to provide evidence of improving the diagnosis and reducing multiple organ damages. Methods We analyzed the patients with scrub typhus admitted to the First Affiliated Hospital of Guangxi Medical University and Liuzhou People's Hospital during January 2009 and December 2013. Results There were 216 patients diagnosed with scrub typhus in the region in five years, and 191 ca-ses (88. 43%) were misdiagnosed in other hospitals. The clinical manifestations were complex, including fever, respiratory symptoms, gastrointestinal symptoms, headache, skin rash and scar, etc. They were mainly misdiagnosed as fever of unknown origin (FUO) (74. 87%), pneumonia (9. 42%), upper respiratory tract infection (6. 81%). Sixty-seven (35. 08%) misdiag-nosed cases were in the district hospitals 64 (33. 51%) in the county hospitals, 30 cases (15. 71%) in private clinics, dispen-sary or health stations, 26 cases (13. 61%) in municipal hospitals, 4 cases (2. 09%) in the provincial hospitals. The first ma-jor diagnostic departments were internal medicine and emergency departments. There were 125 patients (65. 45%) with multiple organ and system damage because of misdiagnosis of scrub typhus, and 16 patients (8. 38%) died. Conclusion The rate of misdiagnosis of scrub typhus has been rising in recent years, mainly in the county hospitals or the lower level medical centers. It is necessary to improve level of diagnosis and treatment of scrub typhus in county hospitals or the lower level medical stations in order to reduce the misdiagnosis rate of scrub typhus.