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目的探讨非系统性眩晕临床误诊原因,提高临床诊治水平。方法回顾分析2008年3月至2012年3月急诊科误诊为系统性眩晕的非系统性眩晕患者23例,根据临床症状、体征、实验室检查、随访,综合确定最终诊断。结果在23例非系统性眩晕患者中,误诊为椎基底动脉供血不足12例,颈椎病8例,梅尼埃病1例,位置性眩晕2例。最后确诊上消化道出血3例,宫外孕2例,三度房室传导阻滞1例,双硫伦样反应2例,水电解质紊乱3例,肾功能衰竭2例,低血糖2例,心肌梗死3例,眼部疾病2例,重度贫血2例,肝癌结节破裂1例。结论非系统性眩晕患者病情重,诊断难度大,涉及知识面广,临床在诊断系统性眩晕时一定要先排除非系统性眩晕的可能。
Objective To investigate the causes of misdiagnosis of non-systematic vertigo and improve the level of clinical diagnosis and treatment. Methods A retrospective analysis of 23 patients with non-systemic vertigo misdiagnosed as systemic vertigo in the emergency department from March 2008 to March 2012 was performed. The final diagnosis was comprehensively determined according to clinical symptoms, signs, laboratory tests and follow-up. Results In 23 patients with non-systematic vertigo, misdiagnosed as vertebrobasilar insufficiency in 12 cases, 8 cases of cervical spondylosis, Meniere’s disease in 1 case, 2 cases of positional vertigo. The final diagnosis of upper gastrointestinal bleeding in 3 cases, 2 cases of ectopic pregnancy, third degree atrioventricular block in 1 case, 2 cases of diclofenac reaction, water and electrolyte disorders in 3 cases, 2 cases of renal failure, hypoglycemia in 2 cases, myocardial infarction 3 cases, 2 cases of eye diseases, severe anemia in 2 cases, 1 case of liver cancer nodules rupture. Conclusion Non-systematic vertigo patients with severe illness, diagnosis is difficult, involving a wide range of knowledge, clinical diagnosis of systemic vertigo must first rule out the possibility of non-systemic vertigo.