高龄老年缺血性肠病45例临床特点分析

Clinical characteristics of 45 elderly cases of ischemic bowel disease

目的分析探讨高龄老年人缺血性肠病的临床患病特点。方法回顾性分析2010年1月—2020年1月空军特色医学中心经检查确诊的高龄老年缺血性肠病患者的一般资料和临床特点,应用SPSS22.0软件对数据进行统计分析,计数资料以率(%)表示,组间样本率比较采用χ2检验中的Fisher确切概率法检验。结果老年缺血性肠病中,大部分起病表现为急性腹痛22例(占48.9%)或亚急性腹痛14例(占31.1%),合计占80.0%。老年缺血性肠病左半结肠型较右半结肠型多发,2组在临床症状上,恶心、呕吐、便血、发热、腹肌紧张、病死率这些指标,右半结肠组明显高于左半结肠组,2组间的差异均有统计学意义(P<0.05)。在合并症上,右半结肠型IBD患者大部分合并有心血管疾病基础如冠心病或房颤(占71.4%),左半结肠型IBD患者大部分合并有便秘(占68.4%),差异具有统计学意义(P<0.05)。结论老年患者容易出现肠壁的血运障碍,从而诱发肠缺血发作(肠卒中)。对肠卒中的认识不足容易导致误诊。因而对于病史和临床特点的熟练掌握,以及及时实施腹部血管CT、腹部超声、结肠镜等进一步检查以尽快明确诊断,对于降低老年缺血性肠病的死亡率至关重要。

Objective To analyze the clinical characteristics of ischemic bowel disease in the elderly.Methods The basic data on and clinical characteristics of elderly patients with ischemic bowel disease diagnosed between January 2010 and January 2020 were retrospectively analyzed.The data was statistically analyzed with SPSS 22.0 software.Results Among the elderly patients with ischemic bowel disease,22 cases(48.9%)had acute abdominal pain and 14 cases(31.1%)had subacute abdominal pain,accounting for 80.0%of the total.Cases of the left colon type outnumbered those of the right colon type.As for clinical symptoms,the incidence of nausea and vomiting,hematochezia,fever,abdominal muscle tension and mortality were significantly higher in the right colon group than in the left colon group(P<0.05).In terms of complications,most of the patients with right colon type IBD had such cardiovascular diseases as coronary heart disease or atrial fibrillation(71.4%),while most of the patients with left colon type IBD developed constipation(68.4%).The difference was statistically significant(P<0.05).Conclusion Elderly patients are vulnerable to intestinal wall blood flow disorders,which can induce intestinal ischemic attack(intestinal stroke).A poor knowledge of intestinal apoplexy can easily lead to misdiagnosis.Therefore,an intimate knowledge of the medical history and clinical characteristics of patients,prompt examinations with abdominal vascular CT,abdominal ultrasound and colonoscopy and a quick and clear diagnosis are critical to reducing the mortality of elderly patients with ischemic bowel disease.