老年人急性弥漫性腹膜炎的临床研究

Clinical study on acute generalized peritonitis in the aged

目的 :探讨老年人急性弥漫性腹膜炎的临床特点及影响预后因素 ,做好围手术期处理 ,以提高老年人急性弥漫性腹膜炎的治疗效果。方法 :对 6 3例 6 0岁以上行急诊剖腹手术的老年人急性弥漫性腹膜炎临床资料进行回顾分析。结果 :老年人急性弥漫性腹膜炎绝大多数是继发性 (95 .2 % ) ,其临床表现不典型 ,首诊较迟 (平均 4 2h) ,从发生腹痛到接受手术较晚 (平均 6 4 .9h) ,术前并存疾病较多 ,术后并发症 (36 .5 % )和死亡率 (2 0 .6 % )高。结论 :接受手术时间、是否有并存疾病、原发疾病类型、并发症类型及腹内情况均是影响预后的因素 ;围手术期处理的关键是 :早期诊断 ,积极处理并存疾病争取早期手术 ,术中严密监测、保护各器官功能 ,术后维护重要脏器功能 ,预防、控制各种并发症的发生。

Objective:To study the clinical characteristics and prognostic factors in aged patients with acute generalized peritonitis(AGP)and make the satisfactory perioperative management of them to improve the curative efficacy.Methods:63 patients aged 60 years and older with AGP under emergency laparotomy were analyzed retrospectively.Results:AGP in aged patients was mostly secondary and had non-typical clinical manifestations.Their first consultation in outpatient clinic was late and the duration from incidence of abdominal pain to operation was long(mean time 42hs and 64.9hs respectively).These patients had a lot of preoperative concomitant diseases and high morbidity(36.5%)and mortality(20.6%) postoperatively.Conclusion:The operation time,concomitant diseases,types of primary diseases.types of complications and situation of abdominal cavity are the factors affecting prognosis.The key to perioperative management should be early diagnosis,preferable treatment for concomitant diseases and early operation,meanwhile,maintaining the important organs' function and preventing and controlling the complications postoperatively are very important.