76例缺血性肠病并出血临床特点分析

Clinical characteristics of ischemic bowel disease and hematochezia:analysis of 76 cases

目的分析缺血性肠病便血(ischemic bowel disease and hematochezia,IBD-H)患者临床特点,提高下消化道出血IBD早期诊断率。方法回顾性分析76例IBD-H患者临床资料,以145例结直肠恶性肿瘤便血(colorectum malignant tumor and hematochezia,CMT-H)患者作为对照,比较两组患者一般资料、临床表现及辅助检查的差异,寻找IBD-H临床特点。结果IBD-H组缺血性结肠炎(ischemic colitis,IC)75例(98.68%),急性肠系膜动脉栓塞1例(1.32%);同CMT-H组比较,IBD-H组3天入院率高(P<0.001),合并高血压病及腹部手术史比例高(P<0.05),合并腹痛、腹泻、呕吐比例高(P<0.05),入院查体腹部压痛比例高(P<0.001),急诊白细胞总数、血红蛋白、纤维蛋白原、D-二聚体及乳酸脱氢酶高(P<0.05);75例IC完成肠镜检查,病变范围均在左半结肠。结论IBD-H患者多数为IC,以女性多见,常有高血压病、腹部手术病史,多在3日内因便血合并腹痛、腹泻或呕吐入院,1/4左右患者入院有腹部压痛,急诊白细胞总数、血红蛋白、纤维蛋白原、D-二聚体及乳酸脱氢酶较高,病变范围仅累及左半结肠。

Objective To investigate the clinical characteristics of the ischemic bowel disease and hematochezia(IBD-H)and improve the early diagnosis rate of IBD among patients due to lower gastrointestinal hemorrhage.Methods Clinical data of 76 patients with IBD-H were analyzed,and 145 patients diagnosed as colorectal malignant tumor and hematochezia(CMT-H)were selected as controls.The differences of general data,clinical features and auxiliary examinations of the two groups were compared to find the characteristics of IBD-H.Results 75 patients(98.68%)of ischemic colitis(IC)and 1 patient(1.32%)of acute mesenteric artery embolism were in the IBD-H group.Compared with the CMT-H group,the IBD-H group had a higher admission rate within 3 days(P<0.001),a higher proportion of hypertension and abdominal surgery history(P<0.05),a higher proportion of abdominal pain,diarrhea and vomiting(P<0.05),and a higher proportion of abdominal tenderness on admission examination(P<0.001).And the emergency number of white blood cells,hemoglobin,fibrinogen,D-dimer and lactate dehydrogenase of the IBD-H group were higher(P<0.05).Colonoscopy was performed in 75 patients of IC and the lesions were all in the left colon.Conclusion Most of IBD-H patients are IC,and most of them are female.They often have hypertension and abdominal surgery history.They are hospitalized due to hematochezia,abdominal pain,diarrhea or vomiting within 3 days,and about 1/4 of the patients have abdominal tenderness.The emergency number of white blood cells,hemoglobin,fibrinogen,D-dimer and lactate dehydrogenase of patients are high,and the lesions are only in left colon.