老年急腹症的临床特点及诊治要点

Clinical characteristics and therapeutic strategy in elderly acute abdomen patients

目的探讨老年急腹症的临床特点及诊治要点。方法回顾性分析老年急腹症216例(老年组)和中青年156例(中青年组)的临床资料,对其病情、症状、伴随疾病、实验室及辅助检查、诊断与治疗、住院时间等进行比较分析。结果老年组以腹胀、肛门停止排气和排便、腹腔积液居多(P<0.01),中青年组则以体温升高、腹部压痛、反跳痛及肌紧张多见(P<0.01);老年组伴随疾病发生率为92.1%,中青年组为29.5%,两组比较差异有统计学意义(P<0.01);老年组手术治疗161例,非手术治疗55例,治愈或好转209例,死亡7例;中青年组手术治疗149例,非手术治疗7例,均治愈出院。老年组平均住院时间(25.5±2.5)d,中青年组(16.5±1.5)d,两组比较差异有统计学意义(P<0.01)。结论老年组急腹症临床表现不典型、伴随疾病多、病情变化快,应重视各种辅助检查,及时早期诊断,合理选择个体化治疗方案,是提高老年急腹症治愈率的关键。

Objective To investigate the clinical characteristics and diagnosis, treatment of elderly patients with acute abdomen. Methods The clinical data of 216 elderly and 156 young and middle - aged acute abdomen patients were analysed retro- spectively. Results The clinical symptoms as abdominal distension, stop evacuation of flatus and stool, abdominis effusion in the elderly group were more common （ P 〈 0.01 ）. Forever, abdominal pain, rebound pain and tense muscle in young and middle - aged group were more common （ P 〈 0.01 ）. There was significant difference in incidence of accompanying diseases between the two group（ P 〈0.01 ） , 161 cases of 216 elderly were operated, 55 cases were no - operated, 209 cases were cured and improved, 7 cases died. 149 cases of 156 young and middle - aged were operated, 7 cases were no - operated, all cases were cured. The average hospitalization time in elderly group was （25.5 ± 2.5 ）d , it was （16.5 ±1.5 ）d in young and middle -aged group, there was significant difference between the two groups （ P 〈 0.01 ）. Conclusions The clinical manifestation of elderly patients with acute abdomen has no specific clinical presentation. It is important to increase the cure rate that laboratory tests, early diagnosis in time and appropriate individual treatment.