小儿急性腹痛的诊断与治疗分析

目的探讨小儿腹痛的临床特点,提高临床诊断率及治疗效果,避免漏诊、误诊。方法回顾性分析我院1998年7月至2010年10月100例以急性腹痛为首发症状的小儿诊断率及治疗效果,总结腹痛病因及治疗方法。结果100例患儿均得到准确的诊断与有效的治疗和处理,未出现漏诊、误诊。结论小儿急性腹痛的病因较多,对其疼痛特点要仔细分析,结合认真的体格检查及辅助检查均能做出准确诊断,从而进行相应的治疗及处理。     

小儿急性腹痛

腹痛是小儿的常见症状.尽管大多数小儿急性腹痛的症状有自限性,但仍然应该视为内、外科的急症来处理.能够早期作出腹痛的正确诊断是最困难的,而这又是开展治疗和抑制病情恶化的关键.本文为小儿急性腹痛的评估提供一个综合的临床指导方针.……     

小儿急性腹痛150例临床分析

目的 探讨小儿急性腹痛的临床特点.方法 对150例急性腹痛患儿的临床资料进行回顾性分析.结果 外科性腹痛17例,内科性腹痛133例.结论 小儿急性腹痛较成年人更应当做到认真询问病史、细致查体,应当综合其年龄特点、部位、性质、伴随症状及辅助检查结果,进行全面分析、归纳、总结,缜密而灵活的思考,方有助于早期得出正确诊断.     

小儿内科急性腹痛的临床诊治分析

目的探讨小儿内科急性腹痛的临床特点及治疗方法,提高临床诊断及治疗效果。方法选取急性腹痛的164例患儿作为研究对象,分析其病因、腹痛部位及治疗前后的疼痛分级。结果164例内科急性腹痛患儿均得到正确的诊断和有效的治疗,无误诊及漏诊发生。与治疗前相比,治疗后的疼痛率明显降低,差异有统计学意义（P〈0．05）。结论小儿内科急性腹痛的病因较为复杂,应根据其病史、发病特点、体格检查和辅助检查积极寻找病因,尽快做出诊断,从而有效地治疗。     

小儿急性腹痛83例病因分析

笔者收集2005年12月—2006年12月,在本院门诊就诊的急性腹痛患儿83例临床资料,并进行病因分析,现报告如下。1临床资料1.1一般资料本组83例,男48例,女35例;年龄1月龄~14岁。其中1~18月龄6例,18月龄~3岁15例,3~5岁32例,5~14岁30例,病程均在3 d内。1.2临床表现1.2.1症状腹痛79例,哭闹不安51例,呕吐39例,呕吐咖啡渣样物3例,腹胀12例,发热29例,腹泻20例,面色苍白、大汗淋漓29例,便秘6例,果酱样大便2例,拒奶5例,双下肢对称性红色皮疹1例。1.2.2体征腹肌紧张12例,满腹压痛34例,剑突下压痛12例,脐周压痛36例,左下腹压痛26例,右下腹压痛17例,麦氏点压…     

小儿内科急性腹痛的临床特点与治疗体会

目的:研究小儿内科急性腹痛的临床特点与治疗的效果.方法:选取在2018年1月-2019年8月来我院就诊的52例内科急性腹痛患儿为研究对象,分析其临床特点,并有针对性的制定治疗措施,观察治疗效果.结果:治疗后患儿的疼痛率19.23％与治疗前44.23％相比较低(p<0.05).结论:小儿内科急性腹痛发病比较急,且伴随着疼...     

80例小儿复发性腹痛治疗体会

小儿复发性腹痛 ,有人称为“再发性腹痛” ,临床上较为多见。腹痛呈慢性、反复发作 ,好发于4岁～10岁儿童 ,发作无定时 ,一天可发作数次或数天发作一次 ,疼痛多发生于脐周、剑突下、上腹部等。腹部检查无阳性体征 ,喜按 ,多在数分钟后自行缓解。个别患儿腹痛伴恶心、出汗、纳差、面色苍白、夜间磨牙等。但很少见夜间被痛醒者。本症虽属功能性腹痛 ,但容易对患儿造成痛苦及烦恼。我们自1999年至2002年对来门诊就诊的80例复发性腹痛患儿进行了综合治疗 ,取得了较好疗效。1一般资料本组患儿80例 ,男32例 ,女48例。疼痛部位在脐周51例 ,上腹部10…     

超声诊断小儿急性胰腺炎1例

患者男，14岁。因持续性腹痛伴恶心、呕吐5小时来就诊。患者于入院前5小时无明显诱因出现上腹疼痛、呈持续性伴阵发性加剧，无发热、寒战，无咳喘、憋闷，伴恶心、呕吐频繁，不能进食，呕吐物为胃内容物，无咖啡渣样物，急行彩超检查，声像图示：胰腺肿大，轮廓不清，胰头厚约2．1cm，胰体厚约1．7cm，胰尾厚约1．8cm，主胰管内径约0．3cm，实质回声减低，胰腺周围弱回声，胰头部气体增多，超声提示：急性胰腺炎。临床以急腹症急诊入院，经抑酸，抗胰酶治疗，后送血、尿去上级医院化验示：血清淀粉酶（AMY）685u／L，尿淀粉酶（AMY）4279u／L，确诊急性胰腺炎，积极治疗13天后出院，出院时声像图示：胰头厚约1．6cm，胰体厚约1．3cm，胰尾厚约1．4cm，主胰管内径0．2cm，实质回声尚均质。     

内科急诊急性腹痛患者260例临床诊断分析

目的观察内科急诊急性腹痛的临床诊断,探讨有效诊断方法。方法选择我院急诊科自2007年6月至2012年6月收治的260例内科急性腹痛患者的临床资料,给予全部患者询问诊断,了解患者病情情况及病史,体格检查,配合实验室及其他辅助检查。结果本组患者经诊断后,确诊急性胃肠炎127例,消化道溃疡58例,细菌性痢疾49例,心肌梗死10例,糖尿病酮症酸中毒6例,尿毒症5例,缺血性结肠炎1例,胃癌3例,肝癌1例。本组误诊5例,准确诊断率为98.3%,误诊率为1.9%。结论急性腹痛患者诊断应采用询问诊断、体格检查诊断、实验室检查等辅助诊断,诊断时应注意全面,以减少误诊率、漏诊率。     

盐酸戊乙奎醚治疗急性腹痛病人的临床观察

目的观察盐酸戊乙奎醚（长托宁）治疗急性腹痛的疗效。方法对入选的68例急性腹痛病人,用长托宁0.01mg/kg肌内注射,用药前手15、30、60、120min进行观察腹痛的强度。结果用药后15、30min腹痛强度与用药前比较,差异有统计学意义（P〈0.05）;用药后60、120min腹痛强度与用药前比较差异均有统计学意义（P〈0.01）。用药前后血压和心率比较,差异无统计学意义。结论用长托宁治疗急性腹痛病人效果较好,临床上可以推广使用。     

胃复安治疗急性感染性腹痛腹泻的临床疗效观察

目的观察胃复安治疗急性感染性腹痛腹泻的临床疗效。方法将涞源县医院2010年3月-2011年5月收治的84例急性感染性腹痛腹泻患者，遵照知情同意原则并按照随机数字表法随机分为两组，对照组42例患者采用常规治疗方法，观察组42例患者在常规治疗基础上加用胃复安治疗，比较分析两组的临床疗效。结果观察组总有效率为97．6％，对照组为81．0％，两组间差异有统计学意义（X2=4．48，P〈0．05），两组均无明显不良反应发生。结论胃复安治疗急性感染性腹痛腹泻疗效满意，且安全性好，是临床首选的治疗药物之一。     

急腹症外科感染性疾病的致病菌及药敏实验研究

目的 探讨急腹症外科感染性疾病的常见致病菌及其对目前常用抗生素的敏感情况。方法 采用VITEK全自动微生物分析仪，对327例急腹症外科感染性疾病患者术中采集标本，进行需氧菌和厌氧菌培养、菌群分离鉴定及药物敏感实验。结果 327例标本中320例有细菌生长，其中需氧菌328株，厌氧菌436株，以G^-菌为主；在需氧菌中以大肠埃菌为主，占176株；厌氧菌中以类杆菌属为主，占219株；大多数为需氧菌和厌氧菌的混合感染，占64．7％；单纯需菌和单纯厌氧菌感染分别占25％和10．3％；需氧菌对第三代头孢菌素的敏感率在90％以上，厌氧菌对甲硝唑（灭滴灵）的敏感率在97．7％。结论 急腹症外科感染性疾病多为厌氧菌和需氧菌的混合感染，G^-菌所占比例较大。所有菌种都是人体正常菌种，条件致病菌和内源性细菌感染是急腹症外科感染性疾病的特征；需氧菌对第三代头孢菌素较为敏感，厌氧菌对甲硝唑仍较为敏感。     

Disaccharidase Deficiencies in Children With Chronic Abdominal Pain

Objectives: Carbohydrate intolerance or malabsorption has been suggested as a cause of chronic abdominal pain (CAP) in a subset of patients. We aimed to evaluate disaccharidase deficiencies in children with functional CAP and to correlate deficiencies with clinical features. Method: Patients presenting to the gastroenterology clinic at Children's Hospital of Wisconsin with abdominal pain prospectively completed a detailed demographic, history, and symptom questionnaire. The CAP cohort included those with at least 1 month of symptoms. Data on disaccharidase activity and histology of endoscopic biopsies were collected retrospectively. Only patients with normal histology were included in the study. The association between groups with low disaccharidases and clinical features was examined. Results: A total of 203 pediatric patients with CAP were included. The mean (SD) age was 11.5 (3.1) years, and 32.5% were male. The percentages of abnormally low disaccharidase levels using the standard laboratory cutoffs were lactase, 37%; sucrase, 21%; glucoamylase, 25%; and palatinase, 8%. Thirty‐nine percent of the patients with low lactase also had low sucrase, and 67% of the patients with low sucrase had low lactase. There was no significant difference in the activities of any of the disaccharidases or sucrase/lactase ratio in relation to age. Also, no association was found between stool consistency, stool frequency, or location of pain and low disaccharidase activity. Conclusions: A large proportion of patients with CAP have deficiencies in disaccharidases. Bowel frequency, vomiting, or location of pain was no different between groups, suggesting that these clinical features cannot be used to predict disaccharidase deficiencies.     

四磨汤联合金双歧治疗功能性再发性腹痛40例

目的探讨四磨汤联合金双歧治疗功能性再发性腹痛的疗效。方法采用随机分组法,将80例功能性再发性腹痛患儿分为2组,对照组40例,给予常规剂量的654-2、颠茄合剂等治疗,治疗组40例,在常规治疗的基础上给予中成药四磨汤口服液10～20mL,1d3次,金双歧1.5,1d3次,3～5d为1个疗程,共治疗3个疗程。2组治疗均以3～5d为1个疗程,共治疗3个疗程。结果治疗组40例中,完全缓解26例,基本缓解10例,无效4例,总有效率90%;对照组40例中,显效10例,有效18例,无效12例,总有效率70.0%,2组疗效比较,差异有统计学意义(P<0.01)。结论四磨汤联合金双歧用于治疗功能性再发性腹痛,简便易行,疗效明显,且未见明显不良反应。     

小儿慢性腹痛110例胃镜病因分析

目的:探讨小儿慢性腹痛病因。方法:应用小儿电子胃镜对110例慢性腹痛患儿进行胃镜检查及快速尿素酶试验。结果:110例患儿中浅表性胃窦炎78例(70.9%),结节状胃炎11例(1%),十二指肠球炎75例(68.2%),十二指肠球部溃疡10例(9%),幽门管对吻溃疡1例(0.9%),其中幽门螺杆菌感染92例(83.6%),7～14岁儿童占77.3%。结论:浅表性胃窦炎、结节状胃炎、十二指肠球炎及消化性溃疡是小儿慢性腹痛的主要病因,且幽门螺杆菌感染率高,7～14岁儿童所占比重较大,小儿电子胃镜是明确病因不可替代的手段,应提倡分餐制或实行共用餐勺取菜,搞好饮食卫生,杜绝传染源。     

Predictors of Chronic Abdominal Pain Affecting the Well-Being of Children in Primary Care

PURPOSE

Abdominal pain is a frequent symptom among children but is rarely associated with organic disease. Although it may persist for years, no factors have been identified that predict its prognosis. Our aim was to determine whether patient characteristics at initial consultation can predict chronic abdominal pain severe enough to influence the child’s well-being at 1 year of follow-up.

METHODS

We conducted this prospective cohort study in primary care, including consecutive children aged 4 to 17 years seen for abdominal pain by their family physician. Multivariate logistic regression analysis was used to identify prognostic factors that predicted chronic abdominal pain 1 year later. Discriminative ability of identified predictors was assessed using the area under the receiver operating characteristic curve and explained variance.

RESULTS

The risk of having chronic abdominal pain at 1 year of follow-up was 37.1% in the cohort overall. Increasing age, waking up at night with pain, high levels of other somatic complaints, and chronic abdominal pain at baseline independently predicted chronic abdominal pain at 1 year. These predictors had a poor to moderate discriminative ability, however; the area under the receiver operating characteristic curve was only 0.69, and the predictors collectively explained only 14.3% of variance in the development of chronic abdominal pain. The absolute risk ranged from 19.4% among children having none of the predictors to 65.5% among children having 3 or 4 predictors.

CONCLUSIONS

Chronic abdominal pain sufficient to affect well-being is common among children initially seen for abdominal pain by family physicians. Although the risk of this outcome increases with number of predictors, these predictors are of limited value in identifying children in whom pain will become chronic, suggesting that other, as yet unidentified factors play an important role.     

急腹症中的罕见病-胆囊扭转12例的诊治体会

目的探讨急腹症中的罕见病胆囊扭转的临床表现,早期诊断与治疗。方法回顾性分析本院1998年2月至2010年12月经手术证实12例胆囊扭转的临床资料。结果 7例胆囊扭转患者胆囊切除术后治愈出院,另5例中3例患者行胆囊造瘘术病情缓解二期再手术治愈,2例患者术后因多器官衰竭死亡。所有12例患者术前均误诊,误诊率100%。结论胆囊扭转无特殊的临床表现,术前确诊困难,早期手术治疗预后较好,术式以开腹胆囊切除术为好。     

人类免疫缺陷病毒感染者的急腹症手术

目的：探讨HIV感染者的急腹症处理方法和效果。方法：总结1997年3月－1999年5月在东非某国收治的8例抗HIV抗体阳性者的急腹症手术治疗经验。结果：8例均接受了急诊手术和抗病毒的药物治疗。共随访6－32个月，7例至今恢复良好，1例腹膜炎行腹腔引流，术后复查CD4淋巴细胞计数＜100／mm^3，3 个月后死于艾滋病。结论：对HIV感染者的急腹症处理，不能歧视，不能拖延，手术治疗效果满意，同时预防HIV在术中、术后的传播和医务人员的自身防护非常重要。