老年脑卒中患者并发急性胆囊炎的临床特征研究

Clinical characteristics of elderly acute cholecystitis patients with stroke

目的 探讨老年脑卒中患者并发急性胆囊炎的临床特征。方法 收集2020年6月~2021年9月在天津中医药大学第一附属医院针灸科住院的老年脑卒中患者671例,观察脑卒中后胆囊炎患者一般资料和胆囊炎发病时临床特征。结果 脑卒中后并发急性胆囊炎12例(1.79%),其中出血性脑卒中1例(8.33%),缺血性脑卒中11例(91.67%),含椎基底动脉病变4例,大脑中动脉病变7例;入院时美国国立卫生研究院卒中量表评分(11.00±3.72)分,合并语言障碍12例(100.00%),肺部感染10例(83.33%),鼻饲进食9例(75.00%);入院至诊断胆囊炎发病时间为4~37(15.67±10.17)d,伴有发热9例(75.00%),腹胀12例(100.00%),压痛或墨菲征阳性3例(25.00%),肝功能异常5例(41.67%);非结石性胆囊炎10例(83.33%),结石性胆囊炎2例(16.67%)。结论 对于同时存在神经损伤严重、高龄且腹胀3个特征的老年脑卒中患者应高度警惕急性胆囊炎的发生。

Objective To study the clinical characteristics of elderly acute cholecystitis patients with stroke.Methods Six hundred and seventy-one elderly acute cholecystitis patients with stroke admitted to our hospital from June 2020 to September 2021 were included in this study.Their general clinical data after stroke and clinical characteristics at onset acute cholecystitis were recorded.Results Of the 12(1.79%) acute cholecystitis patients after stroke, 1(8.33%) was diagnosed with hemorrhagic stroke and 11(91.67%) were diagnosed with ischemic stroke, including 4 with vertebrobasilar artery disease and 7 with middle cerebral artery disease.Their NIHSS score on admission was 11.00±3.72.Of the 12 patients(100.00%) diagnosed with complicated aphasis, 10(83.33%) were diagnosed with lung infection and 9(75.00%) received nasal feeding.The time from admission to diagnosis of acute cholecystitis was 4-37(15.67±10.17) days, and 9(75.00%) were diagnosed with complicated fever.Of the 12 patients(100.00%) diagnosed with abdominal distension, 3(25.00%) had tenderness or positive Murphy’s sign, 5(41.67%) were diagnosed with hepatic dysfunction.10(83.33%) were diagnosed with acalculous cholecystitis, and 2(16.67%) were diagnosed with gallbladder stones.Conclusion Close attention should be paid to acute cholecystitis in very old stroke patients with severe nerve damage and abdominal distension.