华中科技大学医院26例假性腹痛患者临床诊疗体会

Clinical diagnosis and treatment of 26 patients with pseudo abdominal pain in Huazhong University of Science and Technology Hospital

目的:探讨以腹痛为首发症状的急性心肌梗死(AMI)、主动脉夹层(AD)、糖尿病酮症酸中毒(DKA)和肺栓塞等的临床特点及诊疗体会。方法:2014年2月-2019年9月选取假性腹痛患者26例,分析其实验室及影像学检查结果。结果:26例假性腹痛患者中,12例AMI患者,均得到及时诊断和救治;7例AD患者中,死亡3例;5例DKA酸中毒患者中,2例有血淀粉酶升高,均得到明确诊断和治疗;2例肺栓塞患者中,死亡1例。24例急性腹痛患者明确诊断后,得到相应救治,腹痛症状缓解20例。结论:以腹痛为首发症状的AMI、AD、DKA和肺栓塞易与急腹症相混淆,临床医生应对该类假性腹痛患者提高警惕,加强询问病史,提高救治成功率。

Objective:To investigate the clinical characteristics and treatment of acute myocardial infarction,aortic dissection,diabetic ketoacidosis and pulmonary embolism with abdominal pain as the first symptom.Methods:26 patients with pseudo abdominal pain were selected from February 2014 to September 2019,and the results of laboratory and imaging examination were analyzed.Results:Among the 26 patients with pseudo abdominal pain,12 patients with acute myocardial infarction were diagnosed and treated in time.Of the 7 patients with aortic dissection,3 cases died.Among the 5 cases of diabetic ketoacidosis,2 cases had elevated serum amylase,which were definitely diagnosed and treated.Of the 2 patients with pulmonary embolism,1 case died.24 patients with acute abdominal pain were cured after definite diagnosis,and the symptoms of abdominal pain were relieved in 20 cases.Conclusion:Acute myocardial infarction,aortic dissection,diabetic ketoacidosis and pulmonary embolism with abdominal pain as the first symptom are easily confused with acute abdomen,clinicians should pay more attention to the patients with pseudo abdominal pain,strengthen the inquiry of medical history,and improve the success rate of treatment.