以消化道症状为首发表现的儿科危重症临床特点分析

Clinical Characteristics Analysis about Pediatric Critical Illness with Gastrointestinal Symptoms as Starting Performance

目的通过对46例以消化道症状为首发临床表现的儿科危重症进行临床分析,总结该类疾病的临床特点和特殊表现,以加深儿科大夫对该类临床病症的识别和认识。方法选择2010年1月至2015年12月收住或转入PICU住院的46例以腹胀、腹痛、呕吐等消化道症状为首发表现,但最终明确诊断非消化系统疾病的危重患儿作为研究对象,采用回顾性研究,对原发病、临床表现、治疗、转归及预后进行总结分析。结果 46例患儿首发表现中腹胀呕吐25例,腹痛便血11例,腹胀腹痛伴呕吐13例,其中外科疾病34例(占),包括肠套叠14例,完全/不全性肠梗阻7例,内科疾病22例,包括大叶性肺炎5例,过敏性紫癜7例,暴发性心肌炎3例,糖尿病痛症酸中毒5例,中枢神经系统感染6例;入院48小时内即明确诊断38例,误诊18例。结论儿内科几类以腹胀腹痛呕吐等消化道症状为首发表现的特殊疾病,容易被混淆和误诊误治,应引起儿内、外科医生的高度重视,加强临床鉴别,及时正确地诊断原发病,以免延误病情。

Objective To annlysls 46 cases with gastrointestinal symptoms as the starting clinical pediatric critical clinical, and summarize the clinical characteristics of this kind of disease and special performance, to deepen the pediatrician recognition and understanding of the clinical symptoms. Methods In our hospital between January 2010 and December 2015, or turn to PICU 46 patients in the hospital for gastrointestinal symptoms such as abdominal distension, abdominal pain, vomiting, starting performance, but the final diagnosis of diseases of the digestive system of crlticnlly ill patients as the research object, using retrospective study, and the primary disease, c.linical manifestations, treatment and outcome and prognosis were analyzed. Results 46 cases of children with the s^ing performance of 25 eases in abdominal distention and vomiting, abdominal pain stool in 11 cases, 13 cases in abdominal distension abdominal pain with vomiting, 34 cases with surgical disease, including 14 cases intussusception, completely/incomplete ileus in 7 cases, 22 cases in internal disease, including lobar pneumonia in 5 cases, 7 cases in allergic purpura, fuhninant myocarditis （3 cases）, diabetes pains acidosis in 5 cases, 6 cases in central nervous system infection; admitted to hospital within 48 hours of the definite diagnosis of 38 cases, 18 eases of ndadiagnosis. Conclusion Children internal categories in the digestive tract symptoms such as abdominal distension abdominal pain and vomiting for starting performance of the special disease, it is easy to be confused of their errors, the surgeon should attach great importance and strengthen clinical identification, timely correct diagnosis of the primary disease, so as not to delay the treatment.