基层医院急性阑尾炎患者的临床特征及预后转归

Clinical characteristics and prognosis of patients with acute appendicitis in primary hospitals

目的探讨基层医院急性阑尾炎患者的临床特征及治疗转归。方法回顾性分析2015年1月~2018年1月在青岛市即墨区第二人民医院诊断并手术治疗的107例急性阑尾炎患者的临床资料,统计并分析107例急性阑尾炎患者的临床特征;比较107例急性阑尾炎患者手术前后的疼痛情况、白细胞计数、中性粒细胞百分比和C反应蛋白(CRP);统计并分析107例急性阑尾炎患者的治疗效果、术后并发症发生情况、住院时间、住院花费及术后病理检查结果。结果104例(97.20%)患者临床症状以腹痛为主要表现,其中典型转移性右下腹痛72例(67.29%),表现为发热症状101例(94.39%),体温≥38.3℃83例(77.57%);术后3d的疼痛评分、白细胞计数、中性粒细胞百分比及CRP水平低于术前,差异均有统计学意义(P<0.05);手术痊愈104例,治愈率为97.20%,无死亡病例;19例(17.76%)发生术后并发症,其中切口感染11例(10.28%),肠梗阻5例(4.67%),切口脂肪液化3例(2.80%);患者住院时间为(8.59±1.92)d,住院花费为(4479.27±421.04)元。术后病理检查结果包括单纯性阑尾炎13例(12.15%),化脓性阑尾炎68例(63.55%),坏疽性阑尾炎26例(24.30%)。结论急性阑尾炎患者多数以腹痛伴发热为主要临床表现,基层医院行传统手术治疗,治愈率高,术后恢复快,可降低医疗花费,但应加强无菌操作,减少术后并发症的发生,缩短住院时间。

Objective To explore the clinical characteristics and treatment outcome of patients with acute appendicitis in primary hospitals. Methods A retrospective analysis was made of 107 cases clinical data of acute appendicitis diagnosed and treated in the Second People′s Hospital of Jimo District in Qingdao from January 2015 to January 2018, the clinical characteristics of 107 cases of acute appendicitis were analyzed. The pain, white blood cell count and neutrophil percentage and C-reactive protein (CRP) of 107 patients with acute appendicitis before and after operation were compared. The therapeutic effect, complications, hospitalization time, hospitalization cost and pathological examination results of 107 patients with acute appendicitis were analyzed. Results Abdominal pain was the main clinical manifestation in 104 patients (97.20%), among them, 72 patients (67.29%) had typical metastatic right lower abdominal pain, 101 cases (94.39%) had fever, 83 cases (77.57%) had body temperature ≥38.3℃. The pain score, white blood cell count, percentage of neutrophils and CRP level 3 days after operation were lower than those before operation, the differences were statistically significant (P<0.05). 104 cases were cured by operation, the cure rate was 97.20%, there were no deaths. Postoperative complications occurred in 19 cases (17.76%), included 11 cases of incision infection (10.28%), 5 cases of intestinal obstruction (4.67%) and 3 cases of incision fat liquefaction (2.80%). The duration of hospitalization was (8.59±1.92) days, and the cost of hospitalization was (4479.27±421.04) yuan. Postoperative pathological findings included simple appendicitis in 13 cases (12.15%), suppurative appendicitis in 68 cases (63.55%) and gangrenous appendicitis in 26 cases (24.30%). Conclusion Most patients with acute appendicitis have abdominal pain accompanied by fever as their main clinical manifestations. Traditional surgical treatment in grass-roots hospitals has a high cure rate and quick recovery after operation, which can reduce medical expenses. However, aseptic operation should be strengthened to reduce the occurrence of complications after operation and shorten the hospitalization time.