腹型过敏性紫癜与小儿急腹症的鉴别及治疗分析

Identification and treatment of abdominal allergic purpura in children with acute abdomen

目的探讨腹型过敏性紫癜与常见小儿急腹症的区别,分析误诊原因并进行鉴别。方法选取我院2013年8月~2015年8月间收治的20例误诊为小儿急腹症的腹型过敏性紫癜患儿,查看和统计其临床症状及诊断、治疗过程,并分析误诊的原因,根据分析结果结合临床报道,对腹型过敏性紫癜与常见小儿急腹症进行鉴别。结果通过分析认为误诊的客观原因是腹型过敏性紫癜特征性症状延后,主观原因是医师对疾病缺乏认识,检查不够仔细,诊断过于仓促;结合其他临床研究结果得出了腹型过敏性紫癜与消化溃疡、细菌性痢疾、急性坏死性肠炎、肠系膜淋巴结炎以及急性阑尾炎等常见小儿急腹症都有区别,并提出了相应鉴别的方法。结论腹型过敏性紫癜与小儿急腹症的区别是腹部有压痛（痛点不固定）,腹肌紧张和反跳痛不显著,症状重体征轻等;熟练掌握其临床特点,并认真检查和仔细诊断,可有效避免误诊的发生;该病的治疗应以预防为主,确诊后应先找出过敏原并进行避免,严重者可使用抗组胺药物和糖皮质激素进行治疗。

Objective To explore the differences between abdominal allergic purpura and common children acute abdomen, analyze the causes of misdiagnoses and make identifications. Methods 20 children with abdominal allergic purpura who were in our hospital from August 2013 to August 2015 and were misdiagnosed of acute abdomen were selected, their clinical symptoms and treatment processes were reviewed and summarized, and the causes of misdiagnoses were analyzed. According to the analytic results and clinical reports, the abdominal allergic purpura and acute abdomen were identified. Results The analytic results showed that, the objective cause of misdiagnoses was the delayed symptoms of abdominal allergic purpura, while the subjective causes were the doctors＇ lack of disease knowledge, not enough carefully examinations, and hasty diagnoses. Combined with other clinical research results, we concluded that abdominal allergic purpura is different with common children acute abdomen—such as peptic ulcer, bacterial dysentery, acute necrotizing enteritis, mesenteric lymphadenitis, and acute appendicitis, then provided corresponding identification methods. Conclusion Different with common children acute abdomen, the abdominal allergic purpura has the features of abdominal tenderness（pain point is not fixed）, abdominal muscle tension, quietly rebound tenderness, severe symptoms and light signs. Misdiagnosis can be effectively avoided by mastering its clinical features, examining and diagnosing carefully. The therapy of this disease should be based on preventions, and the anaphylactogen should be identified and prevented after diagnoses. Patients with severe symptoms can be treated with antihistaminic drugs and glucocorticoid.