老年人急性腹痛病因分析及诊治体会

Etiology Study and Diagnosis of Acute Abdominal Pain in Elderly People

目的总结老年人急性腹痛的病因,提高临床诊断率及治疗效果,避免漏诊、误诊。方法回顾性分析蚌埠医学院第二附属医院近3年收治的564例以急性腹痛为首发症状的老年患者的临床资料。结果 564例急性腹痛的原因依次分别为:胃十二指肠炎、胆道疾病、消化性溃疡、急性胃肠炎、肠梗阻、急性阑尾炎、急性胰腺炎、急性肠系膜动脉栓塞、肠粘连、泌尿系结石、消化道穿孔、消化道肿瘤、心功能衰竭、心肌梗塞及其它病因不明疾病等;内科急腹症占53%,外科急腹症占47%。诊断主要依据病史、体征、实验室检查及相关辅助检查。结论老年人急性腹痛病因较多,对其疼痛特点要仔细分析,结合细致的体格检查及辅检均能做出准确诊断,继而进行相应有效的治疗。急性腹痛是最常见急症之一,应详细询问病史,注意缺乏典型症状和体征的病例充分利用辅助检查,密切观察,尽早明确诊断,及时治疗,以防误诊、漏诊。

Objective To summarize the cause of acute abdominal pain in elderly people, improve the rate of clinical diagnosis and the treatment effect, and avoid missed diagnosis and misdiagnosis. Methods The clinical data of 564 ehterly patients with acute abdominal pain as the initial symptom which were admitted in hospital in the past 3 years were analyzed retrospectively. Results The reasons of 564 cases of acute abdominal pain in order were ： gastroduodenitis, biliary tract disease, peptic ulcer, acute gastroenteritis, bowel obstruction, acute appendicitis, acute pancreatitis, acute arteria mesenterica embolism, ankylenteron, urinary system calculus, alimentary canal perforation, alimentary system tumor, cardiac failure, heart infarction and other diseases with unknown etiology. There were 53% in MD and 47% in Ch in all acute abdomens. Diagnosis based on the patient history, objective signs, laboratory tests and related auxiliary examination. Conclusion The cause of elderly patients with acute abdominal pain are multiple, in order to make corresponding and effective treatment, we should carefully analyze the characteristics of their pain, combined with careful physical examination and inspection aids can help us to make accurate diagnosis. Acute abdominal pain is one of the most common acute illness in order not to misdiagnosis, we should carefully ask about the history of illness, make full use of auxiliary examination to the patients lack of typical symptoms and physical characteristics, take close observation of them, make clear diagnose early and give them opportunely treatments.