蛛网膜下腔出血的CT漏诊情况分析

目的 探讨各级医院蛛网膜下腔出血（subaraehnoid hemorrhage,SAH）的CT漏诊情况及可能原因.方法 回顾性分析近10年国内文献发表的各医院CT检查漏诊的143例SAH的临床资料.结果 Hunt-Hess Ⅰ、Ⅱ级的SAH患者漏诊率较高（92.4％）.高龄组SAH漏诊率明显高于中年龄段组,差异有统计学意义（P＜0.05）.伴有高血压病、脑卒中病史的SAH患者漏诊率明显低于无此类并发症的患者,差异有统计学意义（P＜0.05）.三级医院漏诊率明显低于一级、二级医院,差异有统计学意义（P均＜0.05）;一级医院相对漏诊风险（odds ratio,OR）是三级医院的2.748倍,差异有统计学意义（OR=2.748）.结论 Hunt-Hess分级较低、非SAH高发年龄段的SAH患者易漏诊,一级医院漏诊率较高,漏诊风险较大,临床应提高警惕.

Missed Diagnosis Analysis of Subarachnoid Hemorrhage by CT Scan

Objective To explore the situation and causes of missed diagnosis of subarachnoid hemorrhage （SAH） disease by computerized tomography （CT） in different hospitals.Methods Clinical data of 143 patients with SAH,who missed diagnosis by CT during the past 10 years,published in China and foreign countries in different hospitals was retrospectively analyzed.Results The missed diagnosis rate of SAH in Hunt-Hess grade Ⅰ and Ⅱ was high （92.4％）.The missed diagnosis rate in elder group was significantly higher than that in middle-aged group （P ＜ 0.05）.The missed diagnosis rate in patients with a history of hypertension and apoplexy was significantly lower than that in patients without these diseases （P ＜ 0.05）.The missed diagnosis rate in thirdgrade class-A hospitals was significantly lower than those in second-grade and first-grade class-A hospitals （P ＜ 0.05） ; the odds ratio （OR） of missed diagnosis in first-grade class-A hospitals was 2.748 times of that of the third-grade class-A hospitals,and the difference was statistically significant （OR =2.748）.Conclusion The Hunt-Hess classification is poor,so the missed diagnosis of SAH is common in patients without high incidence rate of age group ; the missed diagnosis rate of SAH in first-grade class-A hospi tals is high,so clinicians should pay more attention to it.