儿童发热门诊中常见急腹症的早期识别与诊治的探讨

Discussion on early identification,diagnosis and treatment of common acute abdomen in children's fever clinic

目的 探讨儿童发热门诊中常见急腹症的病因,对重型急腹症患儿进行早期识别,为临床治疗提供思路.方法 回顾性分析2022年1月~2022年12月在广州医科大学附属妇女儿童医疗中心发热门诊就诊的52例急腹症患儿的临床资料,根据病史、临床表现、辅助检查等进行总结,分析儿童常见急腹症的临床特点、发病率,根据患儿不同的病情程度给予诊治,并分析治疗效果.结果 52例急腹症患儿中,男33例,女19例,男女比例1.73∶1,常见病因为急性阑尾炎(18例,34.6%),急性肠梗阻(16例,30.8%),嵌顿性腹股沟斜疝(9例,17.3%),肠套叠(6例,11.5%),麦克尔憩室(3例,5.8%).多因素Logistic回归分析结果显示,生命体征不稳定、有基础疾病、剧烈腹痛、有反跳痛、有腹肌紧张以及C反应蛋白(CRP)显著升高是重型急腹症患儿的主要临床特征,可作为早期识别重型急腹症患儿的指标.针对不同病因的急腹症患儿,给予非手术治疗19例,外科手术治疗33例,52例患儿均治愈出院.结论 在儿童发热门诊中,儿童的症状和体征是常见急腹症的重要诊断依据,发生急腹症的病因主要包括急性阑尾炎、急性肠梗阻等,生命体征不稳定、有基础疾病、剧烈腹痛、有反跳痛、有腹肌紧张以及CRP显著升高(>45 mg/L)可作为临床早期识别重型急腹症患儿的指标.

Objective To explore the etiology of common acute abdomen in children's fever clinic,and to identify children with severe acute abdomen early,so as to provide ideas for clinical treatment.Methods The clinical data of 52 children with acute abdomen who were treated in the fever clinic of the Women and Children's Medical Center Affiliated to Guangzhou Medical University from January 2022 to December 2022 were retrospectively analyzed.According to the medical history,clinical manifestations,auxiliary examination,etc.,the clinical characteristics and incidence of common acute abdomen in children were analyzed.Diagnosis and treatment were given according to the different severity of the disease,and the therapeutic effect was analyzed.Results Among the 52 children with acute abdomen,there were 33 males and 19 females,with a male to female ratio of 1.73:1.The common causes were acute appendicitis(18 cases,34.6%),acute intestinal obstruction(16 cases,30.8%),incarcerated indirect inguinal hernia(9 cases,17.3%),intussusception(6 cases,11.5%),and Michael's diverticulum(3 cases,5.8%).Multivariate Logistic regression analysis showed that unstable vital signs,underlying diseases,severe abdominal pain,rebound pain,abdominal muscle tension and significant increase of C-reactive protein(CRP)were the main clinical features of children with severe acute abdomen,which could be used as indicators for early identification of children with severe acute abdomen.For children with acute abdomen of different causes,19 cases were treated with non-surgical treatment,33 cases were treated with surgical treatment,and 52 cases were cured and discharged.Conclusion In children's fever clinic,children's symptoms and signs are important diagnostic basis for common acute abdomen.The causes of acute abdomen mainly include acute appendicitis and acute intestinal obstruction.Unstable vital signs,basic diseases,severe abdominal pain,rebound pain,abdominal muscle tension and significant increase of CRP(>45 mg/L)can be used as indicators for early clinical identification of children with severe acute abdomen.