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目的探讨重型、特重型颅脑损伤合并易漏诊部位损伤的早期诊断和治疗。方法对2000年1月至2007年8月收治的432例重型、特重型颅脑损伤合并其他部位损伤患者的临床资料进行回顾性分析。所有病例均符合重型、特重型颅脑损伤合并其他部位损伤患者的诊断标准,并按损伤严重评分(ISS)和GCS评分对伤情进行评估。同时对漏诊组(50例)和非漏诊组(382例)患者进行分析比较。结果432例患者中有50例漏诊,漏诊率为11.57%。与非漏诊组比较,漏诊组患者ISS评分,GCS≤8的病例所占比例及死亡率均较非漏诊组患者高(P<0.05)。视神经、空腔脏器及脊髓损伤漏诊率较高,这些易漏诊部位损伤的致残率和死亡率也较高。结论对重型、特重型颅脑损伤应重视其视神经、脊髓等合并伤的诊断、规范其诊疗流程,降低漏诊率。
Objective To investigate the early diagnosis and treatment of traumatic injury in severe and extra-severe traumatic brain injury complicated with misdiagnosis. Methods A retrospective analysis was performed on the clinical data of 432 patients with severe and special traumatic brain injury complicated with other parts of the trauma admitted from January 2000 to August 2007. All cases were in line with the diagnostic criteria of patients with severe and special traumatic brain injury and other parts of the injury, and according to the severity of injury score (ISS) and GCS score to assess the injury. At the same time, the patients in the missed diagnosis group (50 cases) and the non-missed diagnosis group (382 cases) were analyzed and compared. Results Of the 432 patients, 50 missed diagnosis and the missed diagnosis rate was 11.57%. Compared with the non-misdiagnosis group, the ISS score, the proportion of cases with GCS≤8 and the mortality rate in the misdiagnosis group were higher than those in the non-misdiagnosis group (P <0.05). The rate of misdiagnosis of optic nerve, hollow organ and spinal cord injury is high, and the disability and mortality rate of damage to these easily missed diagnosis sites are also higher. Conclusion For severe and extra-severe traumatic brain injury, attention should be paid to the diagnosis of optic nerve, spinal cord and other comorbid injuries, to standardize the diagnosis and treatment process and to reduce the rate of misdiagnosis.