本文關(guān)鍵詞：540例兒童消化性潰瘍臨床分析　出處：《重慶醫(yī)科大學(xué)》2016年碩士論文　論文類型：學(xué)位論文

  更多相關(guān)文章： 兒童 消化性潰瘍 臨床分析

【摘要】：目的本文對兒童消化性潰瘍(peptic ulcer,PU)的一般情況、誘因、繼發(fā)因素、家族史、臨床表現(xiàn)、并發(fā)癥、輔助檢查、治療效果等資料進(jìn)行回顧性分析,以提高臨床醫(yī)師對兒童PU的認(rèn)知和診治水平。對象和方法1.對象:重慶醫(yī)科大學(xué)附屬兒童醫(yī)院2005年10月至2015年10月期間所有出院診斷有PU的病例。2.方法:回顧性分析兒童PU相關(guān)臨床資料、電話隨訪結(jié)果等情況。3.統(tǒng)計(jì)學(xué)分析:應(yīng)用SPSS19.0版統(tǒng)計(jì)軟件及Microsoft Office Excel2003進(jìn)行數(shù)據(jù)的統(tǒng)計(jì)和分析,以P0.05為差異有統(tǒng)計(jì)學(xué)意義。結(jié)果1.共收集病例540例,其中男391例(72.4%),女149例(27.6%),男:女=2.6:1,來自城鎮(zhèn)217例(40.2%),農(nóng)村280例(51.9%)。胃潰瘍(gastric ulcer,GU)154例(28.5%),十二指腸潰瘍(duodenal ulcer,DU)357例(66.1%),復(fù)合型潰瘍(composite ulcer,CU)29例(5.4%)。其中嬰兒組18例(3.3%),幼兒組73例(13.5%),學(xué)齡前期組91例(16.9%),學(xué)齡期組220例(40.7%),青少年期組138例(25.6%)。嬰兒期、學(xué)齡期及青少年期組以du為主,幼兒期及學(xué)齡前期組以gu為主。2.發(fā)病前有不潔、不規(guī)律等飲食史的患兒169/540例(31.3%),有nsaids及其他成分不明的“感冒藥”服用史的患兒78/540例(14.4%),有手術(shù)、外傷等應(yīng)激的患兒10/540例(1.9%),有消化道異物病史9/540例(1.7%)。3.存在原發(fā)疾病53/540例(9.8%),其中分別為過敏性紫癜35/53例(66.0%)、急性蕁麻疹7/53例(13.2%)、急性白血病6/53例(11.3%)等。其中嬰幼兒期、學(xué)齡前期組繼發(fā)性潰瘍的發(fā)生率明顯高于學(xué)齡期、青少年組(p0.00833)。4.有胃炎、十二指腸炎、pu家族史的患兒127/540例(23.5%),其中為一級親屬104/540例(19.3%),二級親屬23/540例(4.3%),有幽門螺桿菌(helicobacterpylori,hp)感染的家族史8/540例(1.5%)。其中102/127例(80.3%)為原發(fā)性潰瘍。5.起病癥狀主要有腹痛(274/540例,50.7%)、嘔吐(103/540例,19.1%)及消化道出血(80/540例,14.8%),其次為面色蒼白(37/540例,6.9%)、腹瀉(15/540例,2.8%)、惡心(12/540例,2.2%)、頭暈或頭痛(9/540例,1.7%)等。6.臨床表現(xiàn)主要有腹痛(398/540例,73.7%)、消化道出血(360/540例,66.7%)、嘔吐(352/540例,65.2%)、面色蒼白、乏力、頭暈、暈厥等貧血癥狀(196/540例,36.3%)、食欲減低(130/540例,24.1%)、惡心(99/540例,18.3%)、發(fā)熱(84/540例,15.6%)、反酸和噯氣(46/540例,8.5%)、腹瀉(45/540例,8.3%)、腹脹(23/540例,4.3%)等。其中105/540例(19.4%)表現(xiàn)為慢性腹痛。7.腹痛部位主要在中腹部(125/540例,23.1%),其次為中上腹部(124/540例,23.0%)、上腹部(111/540例,20.6%)。腹痛大部分無明顯時間規(guī)律性(398/540例,73.7%),僅142/540例(26.3%)有明確時間規(guī)律性,其中g(shù)u以進(jìn)食后疼痛為主(14/29例,48.3%),du以饑餓痛和夜間痛為主(61/105例,58.1%;38/105例,36.2%)。8.422/540例(78.1%)發(fā)生有并發(fā)癥,主要為消化道出血(397/540例,73.5%),其次為梗阻(63/540例,11.7%)、穿孔(5/540例,0.9%)。9.535/540例血常規(guī)中wbc計(jì)數(shù)平均為(8.77±5.08)×109/l。wbc計(jì)數(shù)升高占28.4%(152/535例)。hb平均為(95.66±28.98)g/l,貧血占62.1%(332/535例),主要與消化道出血有關(guān)(282/332例,84.9%),其中缺鐵性貧血占15.4%(51/332例)。525/540例血常規(guī)中eos%平均為(1.68±2.63)%,eos%增高占6.5%(34/525例),其中有粘膜組織活檢中eos計(jì)數(shù)增高5例,腸蛔蟲癥1例。10.480/540例肝功能中tp平均為(60.23±9.56)g/l,其中低蛋白血癥占42.7%(205/480例),主要與消化道出血有關(guān)(183/205例,89.3%)。11.289/540例行abo血型鑒定,其中o型血占44.6%(129/289例),a型血占27.7%(80/289例),b型血占22.1%(64/289例),ab型血占5.5%(16/289例)。且存在并發(fā)癥的259例病例中,o型血占45.6%(118/259例),a型血占27.8%(72/259例),b型血占21.6%(56/259例),ab型血占5.0%(13/259例),有無并發(fā)癥發(fā)生的兩組之間血型構(gòu)成比未見統(tǒng)計(jì)學(xué)差異(p0.05)。12.539/540例行無痛胃鏡,gu占28.6%(154/539例),du占66.0%(356/539例),cu占5.4%(29/539例)。13.154例gu中,47.4%(73/154例)為單發(fā),41.6%(64/154例)為多發(fā)。潰瘍位置主要分布在胃竇部(122/154例,79.2%),其次為胃角(25/154例,16.2%)、胃體(10/154例,6.5%)等,其中分布在小彎側(cè)占12.3%(19/154例),大彎側(cè)5.8%(9/154例)。356例du中,50.1%(180/356例)為單發(fā),28.7%(102/356例)為多發(fā),其中霜斑樣占13.8%(49/356例),對吻性占4.2%(15/356例)。潰瘍位置主要分布在球部(292/356例,82.0%),其次為球后(35/356例,9.8%)、球降交界處(30/356例,8.4%),其中前壁占16.3%(58/356例),后壁占12.3%(45/356例)。潰瘍形態(tài)均以圓形或橢圓形為主,其次為不規(guī)則形狀、線狀等。29例cu中,以發(fā)生在胃竇部和十二指腸球部為主(18/29例,62.1%)。其中潰瘍以處于活動期為主(254/539例,47.1%)。14.發(fā)生消化道出血病例中,gu主要發(fā)生在胃竇(82/109例,75.2%)、胃角(23/109例,21.1%),du主要發(fā)生在球部(222/268例,82.8%)、球后(27/268例,10.1%);發(fā)生梗阻病例中,gu主要發(fā)生在胃竇(29/32例,90.6%),其中主要在幽門管(15/29例,51.7%),du主要發(fā)生在球部(10/29例,34.5%)、球降交界處(4/29例,3.8%);發(fā)生穿孔的5例病例中,3例發(fā)生在十二指腸球部,1例發(fā)生在胃竇。15.hp檢測:13c尿素呼氣試驗(yàn)陽性率77.5%(31/40例)�？焖倌蛩孛冈囼�(yàn)陽性率25.8%(117/453例)。組織病理學(xué)檢查陽性率31.1%(19/61例)�？焖倌蛩孛冈囼�(yàn)與組織病理學(xué)檢查對hp感染檢測的陽性率未見統(tǒng)計(jì)學(xué)差異(p0.05),為中度一致性(kappa=0.543,p0.001)。其中hp感染率為25.4%(137/540例),gu中hp感染率為9.1%(14/154例),du中hp感染率為32.2%(115/357例),du的hp感染率明顯高于gu(p0.001)。16.172/540例行組織病理學(xué)檢查,150/172例(87.2%)為慢性、活動性炎癥,15/172例(8.7%)為粘膜充血水腫,13/172例(7.6%)可見灶性潰瘍,3/172例(1.7%)可見灶性壞死。粘膜活檢中eos計(jì)數(shù)大于20個/hpf的病例占15.1%(26/172例),其中有外周血eos%增高5例。17.合并有鑒別意義的疾病有感染性腹瀉11/540例(2.0%)、鼻衄3/540例(0.5%)、腸蛔蟲癥3/540例(0.5%)、膽囊結(jié)石3/540例(0.5%)、肺結(jié)核2/540例(0.37%)、胰腺炎2/540例(0.37%)、幽門前瓣膜2/540例(0.37%)、急性闌尾炎2/540例(0.37%)、腎結(jié)石1/540例(0.19%)。18.共成功電話隨訪69例行hp根除術(shù)病例,依從性100%,其中使用序貫療法27例,顯效率96.3%;使用傳統(tǒng)三聯(lián)療法40例,顯效率85.0%,所有治療方案中均無無效病人。其中序貫療法與傳統(tǒng)三聯(lián)療法抗hp感染的臨床療效未見統(tǒng)計(jì)學(xué)差異(p0.05)。結(jié)論本組中兒童pu以學(xué)齡期兒童為主,以du多見,嬰兒期、學(xué)齡期及青少年期組以du多見,幼兒期及學(xué)齡前期組以gu多見。病前常有不潔、不規(guī)律等飲食史,有非甾體類抗炎藥及其他成分不明的“感冒藥”服用史,有手術(shù)等應(yīng)激因素。pu患兒臨床癥狀不如成人典型,常易誤診,故對有反復(fù)發(fā)作的腹痛、消化道出血、嘔吐及面色蒼白、乏力、頭暈、暈厥等貧血癥狀的患兒;反復(fù)胃腸道不適,且有胃炎、十二指腸炎、PU家族史者等,均應(yīng)警惕PU的可能性,及時行上消化道內(nèi)鏡等相關(guān)輔助檢查,盡早明確診斷,同時需警惕Hp感染,并且積極尋找其他相關(guān)病因、誘因及并發(fā)癥,提高診療水平。
[Abstract]:The purpose of this paper on children's peptic ulcer (peptic ulcer PU) data of the general situation, causes, secondary factors, family history, clinical manifestations, complications, diagnosis and treatment effect were retrospectively analyzed, in order to improve the clinical diagnosis and treatment of water on children's cognitive and PU level. Object and method 1. objects: all cases of PU in the hospital from October 2005 to October 2015 of the Affiliated Children's Hospital of Medical University Of Chongqing. The 2. method: retrospective analysis of children's PU related clinical data, telephone follow-up results, and so on. 3. statistical analysis: the statistics and analysis of data were carried out by SPSS19.0 software and Microsoft Office Excel2003, and the difference was statistically significant with P0.05. Results 1. cases were collected in 540 cases, including 391 male (72.4%), 149 female (27.6%), male: female =2.6:1, 217 from town (40.2%), 280 in rural area (51.9%). Gastric ulcer (gastric ulcer, GU) in 154 cases (28.5%), duodenal ulcer (duodenal ulcer, DU) in 357 cases (66.1%), compound ulcer (composite ulcer, CU) in 29 cases (5.4%). Among them, there were 18 cases (3.3%) in infant group, 73 in infant group (13.5%), 91 in pre school age group (16.9%), 220 in school age group (40.7%) and 138 in teenage group (25.6%). Du was the dominant group in infancy, school age and adolescence, and Gu was the main group in early childhood and pre school age group. 2., there were 169/540 cases (31.3%) with unclean and irregular eating history before onset. There were 78/540 cases (14.4%) with NSAIDs and other unknown components of the "cold medicine" history, 14.4% cases of children with stress and other stressors such as surgery and trauma (1.9%), and a history of gastrointestinal foreign bodies in 9/540 cases (1.7%). 3., there were primary diseases in 53/540 cases (9.8%), including allergic purpura 35/53 cases (66%), acute urticaria 7/53 cases (13.2%), acute leukemia 6/53 cases (11.3%) and so on. The incidence of secondary ulcers in infantile and pre school age group was significantly higher than that of school age group and adolescent group (p0.00833). 4., children with gastritis, duodenal inflammation and family history of PU were 127/540 cases (23.5%), among them were first-degree relatives, 104/540 cases (19.3%), two degree relatives 23/540 cases (4.3%), and family history of Helicobacter pylori (Helicobacterpylori, HP) infection was 8/540 cases (1.5%). Of these, 102/127 cases (80.3%) were primary ulcers. 5. the main symptoms were abdominal pain (274/540 cases, 50.7%), vomiting (103/540 cases, 19.1%), gastrointestinal bleeding (80/540 cases, 14.8%), followed by pale complexion (37/540 cases, 6.9%), diarrhea (15/540 cases, 2.8%), nausea (12/540 cases, 2.2%), dizziness or headache (9/540 cases, 1.7%). The main clinical manifestations were abdominal pain (6. cases of 398/540, 73.7%), gastrointestinal bleeding (360/540 cases, 66.7%), vomiting (352/540 cases, 65.2%), pallor, fatigue, dizziness, syncope and other symptoms of anemia (196/540 cases, 36.3%), and decreased appetite (130/540 cases, 24.1%), nausea (99/540 cases. 18.3%), fever (84/540 cases, 15.6%), acid reflux and belching (46/540 cases, 8.5%), diarrhea (45/540 cases, 8.3%), abdominal distension (23/540 cases, 4.3%). Of these, 105/540 (19.4%) showed chronic abdominal pain. 7. sites of abdominal pain were mainly in the middle abdomen (125/540, 23.1%), followed by middle and upper abdomen (124/540, 23%), upper abdomen (111/540, 20.6%). Most of the abdominal pain had no obvious regularity in time (398/540 cases, 73.7%). Only 142/540 cases (26.3%) had a clear time regularity. Among them, Gu was mainly after eating pain (14/29 cases, 48.3%), and Du was mainly caused by hunger pain and nocturnal pain (61/105 cases, 58.1%, 38/105 cases, 36.2%). 8.422/540 cases (78.1%) had complications, mainly hemorrhage of the digestive tract (397/540, 73.5%), followed by obstruction (63/540, 11.7%), and perforation (5/540, 0.9%). In 9.535/540 blood routine, the average WBC count was (8.77 + 5.08) x 109/l. The increase of WBC count was 28.4% (152/535). The average Hb was (95.66 + 28.98) g/l, and anemia accounted for 62.1% (332/535 cases), which was mainly associated with digestive tract hemorrhage (282/332, 84.9%), of which iron deficiency anemia accounted for 15.4% (51/332). In 525/540 blood routine, the average eos% was (1.68 + 2.63)%, and eos% increased 6.5% (34/525 cases). Among them, there were 5 cases of EOS count in mucosa biopsy and 1 cases of intestinal ascariasis. In 10.480/540 cases, the average TP of liver function was (60.23 + 9.56) g/l, of which 42.7% (205/480 cases) were hypoproteinemia (205/480), which was mainly associated with digestive tract hemorrhage (183/205, 89.3%). The 11.289/540 routine ABO blood group identification, including O-negative blood accounted for 44.6% (129/289 cases), a blood accounted for 27.7% (80/289 cases), B blood type accounted for 22.1% (64/289 cases), blood type AB accounted for 5.5% (16/289 cases). And there are 259 cases of complications, O-negative blood accounted for 45.6% (118/259 cases), a blood accounted for 27.8% (72/259 cases), B blood type accounted for 21.6% (56/259 cases), blood type AB accounted for 5% (13/259 cases), there is no blood complications between the two groups had no statistical difference of ratio (P0.05). 12.539/540 routine painless gastroscopy, Gu accounted for 28.6% (154/539 cases), Du accounted for 66% (356/539 cases), Cu accounted for 5.4% (29/539 cases). Of the 13.154 cases of Gu, 47.4% (73/154 cases) were single, and 41.6% (64/154) were multiple. Ulcer location is mainly distributed in the gastric antrum (122/154 cases, 79.2%), followed by the angle of stomach (25/154 cases, 16.2%), stomach (10/154 cases, 6.5%), which accounted for 12.3% in the distribution of small curved side (19/154), greater curvature 5.8% (9/154 cases). In 356 cases of Du, 50.1% (180/356 cases) were single, 28.7% (102/356 cases) were multiple, of which 13.8% (49/356) were frosting and 4.2% (15/356). The location of ulcer was mainly distributed in the bulb (292/356 cases, 82%), followed by retrobulbar (35/356 cases, 9.8%), and descending junctions (30/356 cases, 8.4%), of which the anterior wall occupied 16.3% (58/356 cases) and the posterior wall occupied 12.3% (45/356 cases). The forms of ulcers were mainly round or oval, followed by irregular shape and linear. In 29 cases of Cu, they were mainly in the gastric antrum and duodenal sphere (18/29, 62.1%). The ulcers were mainly in the active period (254/539, 47.1%). 14. in the cases of gastrointestinal bleeding, Gu mainly occurred in gastric antrum (82/109 cases, 75.2%), gastric horn (23/109 cases, 21.1%), Du mainly occurred in the bulb (222/268 cases, 82.8%), after the ball (27/268 cases, 10.1%); in the cases of obstruction, Gu mainly occurred.
【學(xué)位授予單位】：重慶醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2016
【分類號】：R725.7

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6 吳正治;王濟(jì)國;張曉麗;曹美群;李映紅;李明;;消化性潰瘍唾液蛋白質(zhì)組診斷模型初步研究[A];中國中西醫(yī)結(jié)合學(xué)會診斷專業(yè)委員會2009’年會論文集[C];2009年

7 石拓;時昭紅;;消化性潰瘍中西醫(yī)結(jié)合點(diǎn)思考[A];中華中醫(yī)藥學(xué)會脾胃病分會第二十次全國脾胃病學(xué)術(shù)交流會論文匯編[C];2008年

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9 旦增;楊西霞;劉曉波;巴桑;旺加;色地;占堆;巴珠;;拉薩地區(qū)藏藥、西藥對照治療消化性潰瘍100例的臨床研究[A];加入WTO和中國科技與可持續(xù)發(fā)展——挑戰(zhàn)與機(jī)遇、責(zé)任和對策（下冊）[C];2002年

10 黃平曉;譚詩云;羅小芳;羅和生;;糞鈣衛(wèi)蛋白判斷消化性潰瘍活動性的臨床價(jià)值[A];中華醫(yī)學(xué)會第12次全國內(nèi)科學(xué)術(shù)會議論文匯編[C];2009年

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