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目的:探讨我国有机磷农药中毒误诊的情况和原因,提高对有机磷农药中毒的认识。方法:采用计算机检索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有机磷中毒文献,进行误诊原因分析。结果:符合要求文献共129篇,对纳入文献研究分析显示,误诊病例1 000例,平均误诊率18.69%;误诊范围涉及55种疾病,其中误诊疾病居前3位的是急性胃肠炎、肺炎、食物中毒,占误诊疾病总数的54.1%。误诊原因有11种,医生问诊及体格检查不细致占91.47%,患者主述或代述病史不确切占54.26%,有机磷农药中毒相关知识缺乏占34.11%。1 000例误诊病例中,947例(94.7%)未因误诊误治造成不良后果;40例(4.0%)造成死亡;1例造成手术扩大化或不必要手术。结论:详细询问病史及体格检查,提高对有机磷农药中毒的认识及培养科学的诊断思维方法是减少有机磷农药中毒误诊的主要措施。
Objective: To investigate the situation and causes of misdiagnosis of organophosphorus pesticide poisoning in our country and raise awareness of organophosphorus pesticide poisoning. Methods: The literature of organic phosphorus poisoning, which was published in Chinese medical journals from 2004 to 2013 and was selected for inclusion in the database of misdiagnosis diseases, was used to search the reason of misdiagnosis. Results: A total of 129 articles were found to meet the requirements. The analysis of the included literature showed that 1 000 cases were misdiagnosed and the average misdiagnosis rate was 18.69%. The misdiagnosis scope involved 55 diseases, of which the top 3 misdiagnosed diseases were acute gastroenteritis and pneumonia , Food poisoning, accounting for 54.1% of the total number of misdiagnosed diseases. There were 11 reasons for misdiagnosis, 91.47% were not consulted by medical doctors and physical examinations, 54.26% were unscrupulous, or 34.11% were related to organophosphorus pesticide poisoning. Of the 1 000 misdiagnosed cases, 947 (94.7%) did not have any adverse outcomes due to misdiagnosis or mistreatment; 40 (4.0%) died and one resulted in surgical enlargement or unnecessary surgery. Conclusion: It is the main measure to reduce the misdiagnosis of organophosphorus pesticide poisoning by asking history and physical examination in detail, raising awareness of organophosphorus pesticide poisoning and training scientific diagnostic thinking.