103例缺血性腸病臨床分析
發(fā)布時間：2018-10-15 15:22
【摘要】：目的通過對103例缺血性腸病的臨床分析,提高對缺血性腸病的認識,以早期診斷,及時治療。方法收集2009年1月至2015年12月期間寧夏醫(yī)科大學總醫(yī)院及海南省人民醫(yī)院收治并確診為缺血性腸病103例住院患者的病歷資料,從性別、年齡、臨床表現(xiàn)、原發(fā)疾病、實驗室檢驗、影像學檢查、治療方法和療效等方面,整理并統(tǒng)計數(shù)據(jù),對缺血性腸病進行臨床分析。結(jié)果1.一般資料103例缺血性腸病患者中,男性66例,女性37例,男女比1.783:1。發(fā)病年齡(28-79)歲,平均發(fā)病年齡(52.02±18.25)歲,60歲以上(含60歲)病例76例,占73.78%,40-60歲14例,占13.59%。2.個人史66例男性患者中38例吸煙(57.57%),34例飲酒(51.51%),吸煙、飲酒者28例(42.42%)。3.原發(fā)疾病原發(fā)性高血壓34例(33.01%),冠心病20例(19.42%),糖尿病12例(11.65%),腦梗死2例(1.94%),慢性萎縮性胃竇炎2例(1.94%),高血脂3例(2.91%),類風濕關(guān)節(jié)炎1例(0.970%),患有高血壓、冠心病2例(1.94%),患有高血壓、糖尿病4例(3.88%)。4.診斷及分類急性腸系膜缺血(AMI)82例(79.61%),慢性腸系膜缺血(CMI)5例(4.85%),缺血性結(jié)腸炎(IC)12例(11.65%),未能明確類型的4例(3.88%)。5.臨床表現(xiàn)103例缺血性腸病患者中,腹痛患者101例(98.05%),腹脹患者72例(69.90%),停止排便排氣7例(6.79%),便血患者37例(35.92%),長期便秘患者6例(5.82%),惡心、嘔吐31例(30.09%)。6.腸鏡檢查:6.1病變部位及表現(xiàn)103例缺血性腸病患者中48例行腸鏡檢查,結(jié)果示:病變累及腸段,腸黏膜充血、水腫,散在點狀(片狀、點片狀)糜爛面及淺潰瘍(淺小潰瘍)形成,或提示腸壁黏膜的增厚、腸腔狹窄、局部充血明顯或者呈階段性的改變。病變部位以降結(jié)腸多見(40.69%),其次為乙狀結(jié)腸(26.74%),升結(jié)腸(16.27%),直腸較少見。6.2病理結(jié)果病變黏膜慢性炎癥或以炎癥細胞浸潤。7.實驗室檢驗及影像學檢查7.1檢驗D-二聚體升高者占60.86%,糞便潛血(OB)試驗陽性患者占52.54%,余白細胞水平升高,白蛋白、紅細胞比積水平均有不同程度的下降,但對本病的診斷無特異性。7.2檢查103例患者中60例行腹部彩超檢查,6例行腹部平片檢查,46例行腹部CT檢查,14例行CTA檢查,53例行腸鏡檢查,其陽性率分別為18.33%(11/60),50.00%(3/6),45.65%(21/46),85.71%(12/14),79.24%(42/53)。8.治療與轉(zhuǎn)歸103例患者中,77例患者經(jīng)內(nèi)科保守治療,8例患者經(jīng)內(nèi)科治療無效后行外科手術(shù)治療,18例患者經(jīng)外科手術(shù)治療,其中2例死亡,余患者治療均有效。結(jié)論缺血性腸病以老年男性患者多見,絕大多數(shù)伴有高血壓、糖尿病、冠心病等原發(fā)疾病。臨床表現(xiàn)缺乏特異性,主要以腹痛為首發(fā)癥狀,同時伴有不同程度的腹脹、腹瀉、惡心、嘔吐等胃腸道不適。D-二聚體、糞便潛血試驗、CTA及腸鏡檢查對本病的診斷有一定的參考價值和意義。絕大多數(shù)以內(nèi)科治療為主,部分病例經(jīng)外科手術(shù)治療,療效均好。
[Abstract]:Objective to improve the understanding of ischemic bowel disease by clinical analysis of 103 cases in order to make early diagnosis and timely treatment. Methods from January 2009 to December 2015, the medical records of 103 hospitalized patients with ischemic bowel disease were collected from the General Hospital of Ningxia Medical University and the people's Hospital of Hainan Province. The clinical data of ischemic bowel disease were analyzed in laboratory examination, imaging examination, treatment method and curative effect. Result 1. General data 103 patients with ischemic bowel disease, 66 men, 37 women, male to female ratio of 1.783: 1. The age of onset was (28-79) years, the average age of onset was (52.02 鹵18.25) years. There were 76 cases over 60 years old (including 60 years old), accounting for 73.78 years and 40-60 years old in 14 cases, accounting for 13.59.2. Of 66 male patients, 38 (57.57%) smoked, 34 (51.51%) drank alcohol, and 28 (42.42%) drank alcohol. Primary diseases included essential hypertension in 34 cases (33.01%), coronary heart disease in 20 cases (19.42%), diabetes in 12 cases (11.65%), cerebral infarction in 2 cases (1.94%), chronic atrophic sinusitis in 2 cases (1.94%), hyperlipidemia in 3 cases (2.91%), rheumatoid arthritis in 1 case (0.970%), hypertension in 2 cases (1.94%), and coronary heart disease in 2 cases (1.94%). 4 cases (3.88%) of diabetes mellitus. 82 cases (79.61%) were diagnosed and classified as acute mesenteric ischemia (AMI), 5 cases (4.85%) were chronic mesenteric ischemic (CMI), 12 cases (11.65%) were ischemic colitis, 4 cases (3.88%) were not definite type. Among 103 patients with ischemic bowel disease, 101 (98.05%) had abdominal pain, 72 (69.90%) had abdominal distention, 7 (6.79%) had stopped defecation and exhaust, 37 (35.92%) had blood constipation, 6 (5.82%) had long-term constipation, 31 (30.09%) had nausea and vomiting. Endoscopic examination: 6.1 lesions and manifestations of 103 patients with ischemic bowel disease in 48 cases, the results showed that: lesions involving the intestinal segment, intestinal mucosal congestion, edema, scattered (flaky), The formation of erosive surfaces and shallow ulcers (shallow small ulcers) may indicate the thickening of the mucous membrane of the intestinal wall, the stricture of the lumen, and the obvious or periodic changes of local congestion. Descending colon (40.69%), sigmoid colon (26.74%), ascending colon (16.27%), rectum were rare. In laboratory and imaging examination 7.1, the percentage of patients with elevation of D-dimer was 60.86. The percentage of patients with positive (OB) test in fecal occult blood accounted for 52.54. The level of residual white blood cells increased, albumin and erythrocyte decreased in different degrees. However, there was no specificity in the diagnosis of this disease. The positive rates were 18.33% (11 / 60), 50.00% (3 / 6), 45.65% (21 / 46), 85.71% (12 / 14) and 79.24% (42 / 53), respectively. The positive rates were 18.33% (11 / 60), 50.00% (3 / 6), 45.65% (21 / 46), 85.71% (12 / 14) and 79.24% (42 / 53), respectively. Among 103 patients, 77 patients received conservative medical treatment, 8 patients received surgical treatment after ineffective medical treatment, and 18 patients received surgical treatment. Among them, 2 patients died. All the remaining patients were treated effectively. Conclusion Ischemic bowel disease is more common in elderly male patients, most of them are accompanied by hypertension, diabetes, coronary heart disease and other primary diseases. Clinical manifestations lack specificity, mainly with abdominal pain as the first symptom, accompanied by varying degrees of abdominal distension, diarrhea, nausea, vomiting and other gastrointestinal discomfort. Fecal occult blood test, CTA and colonoscopy have certain reference value and significance for the diagnosis of this disease. Most of the cases were treated by internal medicine, and some cases were treated surgically.
【學位授予單位】：寧夏醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R574
本文編號：2272959
[Abstract]:Objective to improve the understanding of ischemic bowel disease by clinical analysis of 103 cases in order to make early diagnosis and timely treatment. Methods from January 2009 to December 2015, the medical records of 103 hospitalized patients with ischemic bowel disease were collected from the General Hospital of Ningxia Medical University and the people's Hospital of Hainan Province. The clinical data of ischemic bowel disease were analyzed in laboratory examination, imaging examination, treatment method and curative effect. Result 1. General data 103 patients with ischemic bowel disease, 66 men, 37 women, male to female ratio of 1.783: 1. The age of onset was (28-79) years, the average age of onset was (52.02 鹵18.25) years. There were 76 cases over 60 years old (including 60 years old), accounting for 73.78 years and 40-60 years old in 14 cases, accounting for 13.59.2. Of 66 male patients, 38 (57.57%) smoked, 34 (51.51%) drank alcohol, and 28 (42.42%) drank alcohol. Primary diseases included essential hypertension in 34 cases (33.01%), coronary heart disease in 20 cases (19.42%), diabetes in 12 cases (11.65%), cerebral infarction in 2 cases (1.94%), chronic atrophic sinusitis in 2 cases (1.94%), hyperlipidemia in 3 cases (2.91%), rheumatoid arthritis in 1 case (0.970%), hypertension in 2 cases (1.94%), and coronary heart disease in 2 cases (1.94%). 4 cases (3.88%) of diabetes mellitus. 82 cases (79.61%) were diagnosed and classified as acute mesenteric ischemia (AMI), 5 cases (4.85%) were chronic mesenteric ischemic (CMI), 12 cases (11.65%) were ischemic colitis, 4 cases (3.88%) were not definite type. Among 103 patients with ischemic bowel disease, 101 (98.05%) had abdominal pain, 72 (69.90%) had abdominal distention, 7 (6.79%) had stopped defecation and exhaust, 37 (35.92%) had blood constipation, 6 (5.82%) had long-term constipation, 31 (30.09%) had nausea and vomiting. Endoscopic examination: 6.1 lesions and manifestations of 103 patients with ischemic bowel disease in 48 cases, the results showed that: lesions involving the intestinal segment, intestinal mucosal congestion, edema, scattered (flaky), The formation of erosive surfaces and shallow ulcers (shallow small ulcers) may indicate the thickening of the mucous membrane of the intestinal wall, the stricture of the lumen, and the obvious or periodic changes of local congestion. Descending colon (40.69%), sigmoid colon (26.74%), ascending colon (16.27%), rectum were rare. In laboratory and imaging examination 7.1, the percentage of patients with elevation of D-dimer was 60.86. The percentage of patients with positive (OB) test in fecal occult blood accounted for 52.54. The level of residual white blood cells increased, albumin and erythrocyte decreased in different degrees. However, there was no specificity in the diagnosis of this disease. The positive rates were 18.33% (11 / 60), 50.00% (3 / 6), 45.65% (21 / 46), 85.71% (12 / 14) and 79.24% (42 / 53), respectively. The positive rates were 18.33% (11 / 60), 50.00% (3 / 6), 45.65% (21 / 46), 85.71% (12 / 14) and 79.24% (42 / 53), respectively. Among 103 patients, 77 patients received conservative medical treatment, 8 patients received surgical treatment after ineffective medical treatment, and 18 patients received surgical treatment. Among them, 2 patients died. All the remaining patients were treated effectively. Conclusion Ischemic bowel disease is more common in elderly male patients, most of them are accompanied by hypertension, diabetes, coronary heart disease and other primary diseases. Clinical manifestations lack specificity, mainly with abdominal pain as the first symptom, accompanied by varying degrees of abdominal distension, diarrhea, nausea, vomiting and other gastrointestinal discomfort. Fecal occult blood test, CTA and colonoscopy have certain reference value and significance for the diagnosis of this disease. Most of the cases were treated by internal medicine, and some cases were treated surgically.
【學位授予單位】：寧夏醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R574
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