老年糖尿病患者并发急性阑尾炎38例临床分析

Clinical analysis of 38 elderly patients with diabetes complicating acute appendicitis

目的：探讨老年糖尿病并发急性阑尾炎患者临床特点及诊治要点。方法：对我院收治的38例老年糖尿病并发急性阑尾炎患者临床资料进行回顾性分析。结果：38例血糖控制在6.1-10.0mmol/L，34例患者在入院12h内接受手术治疗。4例因诊断延误，在人院48h手术治疗。单纯阑尾炎切除31例，阑尾切除加腹腔引流6例，阑尾周围脓肿切开引流1例，治愈30例，4例（10.5％）出现切口皮肤发红，轻度感染，经换药和抗生素治疗后伤口愈合好，顺利拆线；2例（5．3％）并发肺部感染，其中l例呼吸衰竭，经口气管插管后，转上级医院进一步治疗，另1例经相关对症治疗后好转；1例（2．6％）合并泌尿系感染；死亡l例（2．6％）。结论：老年糖尿病并发急性阑尾炎有其独到的特点，其阑尾炎坏疽及穿孑L率较高，应早期诊断，积极手术，减少并发症的出现。

To investigate the clinical features and treatment points in elderly patients with diabetes complicating acute appendicitis.Methods ：The clinical data in 38 elderly cases of diabetes complicating acute appendicitis in our hospital were retrospectively analyzed.Results ：Blood glucose in 38 cases was controlled in 6.1-10.0 mmol/L,34 cases underwent surgery within 12 h after admission.4 cases received surgical treatment at hospitalized 48h because of delayed diagnosis. 31 cases received simple resection of appendicitis.6 cases were performed appendectomy and intraperitoneal drainage.One case received periappendieeal abscess incision and drainage.30 cases were cured ,4 cases （10.5%） had redness in incision skin and cured by changing dressing and antibiotic treatment. In 2 cases （5.3%） of pulmonary infection ,one case with respiratory failure was transferred to another hospital for further treatment and another case was cured after relative symptomatic treatment. One case. （2.6%） was complicated with urinary tract infection. One patient died （2.6%）.Conclusion：Acute appendicitis in elderly diabetic patient has its unique characteristics with the high rate of appendicitis gangrene and oerforation,which should be early diagnosed and actively operated to reduce the complications.