老年人缺血性肠病27例临床表现和误诊分析

Analysis of clinical features and cause of misdiagnosis in treating 27 elderly patients with ischemic bowel disease

目的探讨老年人缺血性肠病的临床特点、误诊原因,提高对本病的认识和治疗效果。方法回顾性分析27例缺血性肠病的伴随疾病、临床表现、误诊原因、内镜特点及治疗方法。结果 27例中有9例误诊,误诊率为33.3%,25例给予内科保守治疗,手术和肠系膜血管溶栓治疗各1例,均治愈和缓解。结论缺血性肠病以腹痛、便血、腹泻为主要表现,缺乏特异性,误诊率高,在老年人有高血压、心血管病、房颤及糖尿病时发病率高。及时完善肠系膜血管造影及结肠镜检查,早期诊断,及时综合治疗是决定预后的关键。

Objective To analyze the clinical features and cause of misdiagnosis in order to strengthen the clinical cognition on ischemic bowel diseases and improve effect of treatment as well as prognosis in the elderly.Methods Accompanying diseases,clinical manifestation,the cause of misdiagnosis,endoscopic features and therapy of 27 patients with ischemic bowel disease were retrospectively analyzed.Results 9 patients were misdiagnosed,with a misdiagnosis rate of 33.3%.27 patients were cured or became anesis by internal conservative treatment,surgery and interventional therapy.Conclusion The clinical manifestation of ischemic bowel disease lacks specificity with high misdiagnosis rate,the main clinic signs are abdominal pain,hemafecia and diarrhea.Higher incidence is found in elder patients with correlated hypertension,cardio-vascular disease,atrial fibrillation and diabetes,the key to improve the prognosis is as quickly as possible to perform CT,angiography and electronic endoscopic examination to ascertain early diagnosis and appropriate treatment.