327例老年人急性腹膜炎的临床特点及影响预后因素分析

The clinical characteristics and prognostic factors in 327 elderly patients with acute peritonitis

目的 :探讨老年人急性腹膜炎的临床特点及影响预后因素。方法 :对 32 7例 60岁以上老年人急性腹膜炎的临床资料进行回顾分析。结果 :老年人急性腹膜炎绝大多数是继发性 (97.2 % ) (急性感染占 46.5% ,急性穿孔占 48.6% ) ,其临床表现不典型 ,易被误诊、漏诊。本组患者手术治疗 2 74例 ,治愈 2 53例 (92 .3% ) ,死亡 2 1例 (7.7% ) ;保守治疗 53例 ,治愈 43例 (81 .1 % ) ,死亡 1 0例 (1 8.9% ) ,两者比较差异有显著意义 (P<0 .0 5)。结论 :老年人急性腹膜炎有就诊延迟 ,临床表现不典型 ,漏诊、误诊率高的特点。术前并存疾病及手术延迟是影响预后的主要因素。早期正确诊断 ,早期手术 ,积极处理并存疾病是提高疗效的关键。

Objective: To a nalyze the clinical characteristics and progno stic factors in elderly patients wit h acute peritonitis Methods: 327 pat ients aged 60 years and older with a cute peritonitis were analyzed retro spectively Results: The cause of ac ute peritonitis in elderly patients, which was easy to be missed or erron eously diagnosed because of its non typical clinical manifestations,was mostly secondary(97 2%),including ac ute infection(46 5%) and perforation (48 6%) 274 cases were treated surgi cally,253 of which were cured(92 3%) while 21 died(7 7%);53 cases were t reated conservatively,43 of which we re cured(81 1%)while 10 died (18 9%) The difference in therapeutic effect s between operative and conservative treatments was significant( P <0 05) Conclusion: Acute peritonitis in el derly patients is characterized by a delay for treatment,non typical cli nical manifestations and a high rate of missed or erroneous diagnosis Th e preoperative concomitant diseases and delayed operation are the main risk factors for postoperative morbi dity and mortality To achieve better therapeutic effects,the doctor shou ld make a correct diagnosis,perform an operation and treat the concomita nt diseases as early as possible