老年人急性腹膜炎的临床研究

A Clinical Study of Acute Peritonitis in Aged Patient

为探讨７０岁以上老年人急性腹膜炎围手术期处理，对２８３例施行了急诊剖腹手术的７０岁以上老年人急性腹膜炎的临床资料进行了分析。结果显示：原发疾病有腹内脏器急性感染１５２例（５３．７％），腹内脏器急性穿孔９６例（３３．９％），各种绞窄性肠梗阻３０例（１０．６％），原发性腹膜炎５例（１．８％）。其临床表现不典型（６７．４％），易被误诊、漏诊（３４．８％）；直肠指诊和诊断性腹腔穿刺对诊断意义重大。结果提示：７０岁以上老年人急性腹膜炎围手术期处理关键是术前在处理好并存疾病的同时做到早诊断、早手术，术中严密监测病人生命体征、血气和水电解质酸碱平衡，术后维护重要脏器的功能。

To study the perioperative management of aged patients with acute peritonitis (AP), we analysed the clinical data of 283 cases of acute peritonitis, whose ages were over 70 years old, treated with emergency operations retrospectively. The result showed that the causes of AP were acute infection of intraabdominal organs in 152 cases, acute perforation of intraabdominal organs in 96 cases, strangle intestinal obstruction in 30 cases, primary peritonitis in 5 cases. The clinical presentation was untypical in 67.4% of patients and the misdiagnosis rate was 34.8% in this series. Rectal digital examination and abdominal paracenteses are important for the preoperative diagnosis. The results indicate that the main points of the perioperative treatment in aged patients with acute peritonitis are as follows: before operations the complicated diseases should be treated well, and the diagnosis and operations should be done as early as possible, meanwhile, maintaining the water electrolyte balance, and the important organs' function and preventing the complications are very important.