脊髓损伤后急腹症临床特点的细化及机制分析

Refinement of Clinical Features and Mechanism of Acute Abdominal Emergency after Spinal Cord Injury

目的总结脊髓损伤患者急腹症的临床表现、体征特点,探讨诊断经验。方法对2010年1月至2019年2月在中国康复研究中心就诊的14岁以上脊髓损伤(spinal cord injury,SCI)患者的病历进行回顾性分析。结果全部4396名脊髓损伤患者中排除损伤水平T12以下患者,共38例新发急腹症病例。急性胆囊炎相关疾病16例,肠梗阻15例,胰腺炎3例,阑尾炎2例,脏器穿孔破裂2例。脊髓损伤AIS分级A级25例,B级3例,C级8例,D级2例。首发症状为腹胀者24例,腹痛者17例,腹肌紧张者仅3例。脊髓损伤人群中胆囊炎发病率为0.36%,肠梗阻发病率为0.34%。严重急腹症4例:胃穿孔1例,小肠破裂1例,急性坏疽性胆囊炎2例。均无急腹症典型体征。结论通过急腹症常见经典表现及体征进行诊断不适用于高位脊髓损伤人群。急性胆囊炎是脊髓损伤患者急腹症最常见病因。脊髓损伤急腹症患者最常见主诉为腹胀,有腹痛表现者不足50%,腹肌紧张者鲜见。当脊髓损伤患者出现改变体位无法纠正的低血压、肌张力异常增高、漏尿量异常增加等情况时应想到腹腔脏器受损可能。影像学、实验室检查是提高脊髓损伤患者急腹症诊断率的有效手段。

Objective To summarize the clinical manifestations and signs of acute abdominal emergency(AAE) in patients with spinal cord injury(SCI).Methods The medical records of SCI patients over 14 years old admitted to China rehabilitation research center from January 2010 to February 2019 were retrospectively analyzed. Results All the 4 396 patients with SCI were included,and a total of 38 patients were newly diagnosed with AAE.There were 16 cases of acute cholecystitis,15 cases of intestinal obstruction,3 cases of pancreatitis,2 cases of appendicitis and 2 cases of perforation and rupture of viscera.The AIS classification of SCI was grade A in 25 cases,grade B in 3 cases,grade C in 8 cases,and grade D in 2 cases.The first symptom was abdominal distension in 24 cases,abdominal pain in 17 cases,abdominal muscle tension in only 3 cases.The incidence of cholecystitis and ileus was 0.36% and 0.34% respectively.4 case of severe AAE:1 gastric perforation,1 intestinal rupture and 2 acute gangrene cholecystitis.None had typical signs of AAE.Conclusion The diagnosis of AAE based on the classic manifestations and signs is not suitable for patients with high level SCI.Acute cholecystitis is the most common cause of AAE in patients with SCI.Abdominal distension is the most common complaint in patients in AAE with SCI.The possibility of abdominal organ damage should be considered when patients with SCI experience hypotension that cannot be corrected due to change of body position,abnormal increase of muscular tone and abnormal increase of urine leakage.Imaging examination and laboratory examination are effective means to improve the diagnosis rate of AAE in patients with SCI.