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我们对我院１９８９～１９９４年６７例老年排菌肺结核病人的误诊原因进行了分析。结果发现，６７例病人中，误诊时间在６个月以上者７例，３个月以上者２０例，２个月以上者１５例，１个月以上者２５例；病人治疗２个月后，痰菌阴转３８例，阴转率５６６％；６７例病人中有合并症者６０例，其中有两种以上合并症者４１例，合并症中患糖尿病２０例，呼吸系统疾病２８例。误诊在综合医院的有４５例，误诊在专科医院的有７例；由于个人不重视，自服药所致延误诊断１５例。首次作过痰检的仅有１０例，误诊病例的诊断依据９３５％仅靠Ｘ线表现或症状、体征，误诊病例的就诊症状表现为咳嗽、咯痰的占５９７％，其它中毒症状如发热、盗汗、胸痛占１９４％。老年肺结核的病例发现常以因症就诊为主，但由于合并症多，临床症状常不典型，易与其它疾病混淆，因此临床诊断必须依靠痰菌检查。所以，医务人员必须正确掌握老年肺结核的临床特征及诊治原则，从而降低误诊率。
We analyzed the causes of misdiagnosis of 67 elderly patients with pulmonary tuberculosis from 1989 to 1994 in our hospital. The results showed that 67 cases of patients, misdiagnosis time of 6 months or more in 7 cases, more than 3 months in 20 cases, more than 2 months in 15 cases, more than 1 month in 25 cases; patient treatment for 2 months, 38 cases of sputum negative conversion, negative conversion rate of 56.6%; 67 patients with complications in 60 cases, of which more than two cases of complications in 41 cases, complications of diabetes in 20 cases, respiratory diseases in 28 cases . There were 45 cases misdiagnosed in general hospitals and 7 cases misdiagnosed in special hospitals. Due to personal neglect, 15 cases were diagnosed as delayed due to medication. The first sputum examination made only 10 cases, the diagnosis of misdiagnosis based on 93 5% X-ray alone or by symptoms, signs, misdiagnosed cases of symptoms of cough, expectoration accounted for 59 7%, other poisoning Symptoms such as fever, night sweats, chest pain accounted for 19 4%. Elderly cases of pulmonary tuberculosis often find symptomatic treatment, but due to more complications, clinical symptoms are often not typical, and other diseases easily confused, so the clinical diagnosis must rely on sputum examination. Therefore, medical staff must correctly understand the clinical features of elderly pulmonary tuberculosis and diagnosis and treatment principles, thus reducing the misdiagnosis rate.