麻痹性肠梗阻床旁腹部平片特征分析

Image Feature of Portable Plain Abdominal Radiograph of Patients with Paralytic Ileus

目的探讨危重病患者麻痹性肠梗阻床旁腹部平片的影像学特征。方法以南方医科大学附属小榄医院ICU内2008-01/2010年-06发生麻痹性肠梗阻的34例患者为研究对象,全部患者均行床旁腹部平片检查,统计发生麻痹性肠梗阻的病因,分部位统计肠腔积气、积液、肠管扩张等麻痹性肠梗阻的影像学特征的发生率。结果全部患者中胃、小肠、结肠、直肠具有积气征的患者27(79.41%)例,具体病例中仅2～3个部位积气。肠管扩张患者6(17.64%)例,扩张程度小。仅1(2.94%)例可见气液平并见肠粘膜影呈弹簧状。7(20.58%)例患者全消化道无积液积气征象。结论危重病患者麻痹性肠梗阻不具有典型麻痹性肠梗阻的X线征象,判读腹部平片时应结合临床症状、体格检查、病情的连续观察以及CT等检查的排除性诊断。

Objective To study the image feature of portable plain abdominal radiograph of critically ill patients with paralytic ileus.Methods Thirty-four ICU patients in Xiaolan people＇s hospital,who suffered from paralytic ileus from January,2008 to June,2010 were the subjects.All the patients underwent a portable plain abdominal radiograph,with the causes of paralytic ileus were investigated.The incidence rate of pneumatosis and effusion in the enteric cavity,and of intestine dilatation was calculated.Results Tweenty-seven patients（79.41%） out of the 34 suffered from pneumatosis in the stomach,small intestine,colon,or rectum,and the pneumatosis could only be found in two to three places.Six patients（17.64%） suffered from dilatation of intestine,were not serious.Only 1 case（2.94%） demonstrated gas-fluid level and coil spring-like image of intestinal mucosa.Seven cases（20.58%） showed neither pneumatosis nor effusion in the whole alimentary canal.Conclusions Critically ill patients suffered from paralytic ileus has no typical X-ray feature.When the plain abdominal radiograph was interpreted,the clinical symptoms,the continuous observation of the patient＇s condition,the results of the physical examination and CT scan should be taken into consideration in order to establish an accurate diagnosis.