绞窄性肠梗阻诊断指标的Meta分析与筛选

Meta-analysis and screening for diadynamic criterias of strangulated intestinal obstruction

目的筛选绞窄性肠梗阻的诊断指标与方法,以提高其确诊率。方法运用循证医学"研究证据、临床经验和患者需求"三要素,从我院已治疗过的和文献报道的共计652例绞窄性肠梗阻患者的年龄、性别、腹痛、腹胀、恶心、呕吐、停止排气便、腹型、腹肌紧张、压痛、反跳痛、腹部平片阳性、血气分析、CO2CP、凝血功能等26项指标中,通过Meta分析进行筛选,并应用于652例绞窄性肠梗阻和604例单纯性肠梗阻患者、检验其效果。结果筛选了10项诊断绞窄性肠梗阻的指标:①腹痛不缓解或腹胀加重;②T≥38℃;③P≥100次/分;④WBC≥15×109/L;⑤Hb≤90 g/L;⑥腹部不对称,可见肠型及蠕动波;⑦有腹膜刺激征;⑧腹腔穿刺为暗红色血性液体,或为淡黄色液体、镜检有较多的红细胞;⑨影像学显示肠襻固定性扩张加重;⑩休克。绞窄性肠梗阻患者中符合≥2项指标占92%,而单纯性肠梗阻为0。结论所确定的诊断指标与方法为绞窄性肠梗阻所特有,在确诊肠梗阻的基础上,符合≥2项指标者就可诊断为绞窄性肠梗,它可使绞窄性肠梗阻的确诊率由过去的61%提高到92%,且简便、易记。

Objective To screen diadynamic criterium of strangulated intestinal obstruction for raising it＇ s correct diagnosis rate. Methods 26 indexes of 652 strangulated intestinal obstruction patients who were treated in our hospital or were reported in documents were admitted to analyze, which included age, sex, bellyache, abdominal distension, nausea, vomitting, aerofluxus and defecation ceased, intestinal shape, tension of abdominal muscles, tenderness, rebounding pain, plain abdominal x-ray, blood gas analysis, CO2CP, blood coagulation func- tion, and etc. We screened the indexes by Meta-analysis according to the three essential elements of Evi-dence-Based Medicine, which is “investigate evidences, clinical experiences and patient＇ s requirements”. We further applied these indexes to a certain quantitative strangulated intestinal obstruction cases and simple intestinal obstruction cases to test their practical effect. Results Ten diagnostic indexes of strangulated intestinal obstruc- tion were picked out. They were：①unrelieved bellyache or aggravated abdominal distention;② T≥38℃; ③P≥100 t/Min; ④WBC≥15×10^9/L;⑤Hb ≤90 g/L; ⑥abdominal part is dissymmetry, intestinal shape and peri- staltic waves; ⑦peritoneal irritation sign; ⑧madder red haematodes abdominal cavity puncture fluid or it shows amber liquid with many red blood cells under microscopic examination; ⑨fixed and expanded aggravately ansa intestinalis under mageological tests; ⑩shock. On the basis of definite ileac, the patients who conformed to two or above indexes could be diagnosed as strangulated intestinal obstruction. According to this diadynamic criteria and method, the correct diagnositic rate of 625 strangulated intestinal obstruction patients was 92%, while none of 604 simple intestinal obstruction patients was diagnosed as strangulated intestinal obstruction. Conclusion These diadynamic criterium and methods are especially possessed by strangulated intestinal obstruction and the correct diagnositic rate rises from the past 61% to 92%. They are also simple, convenient and easy to remember.