急性腹痛82例病例研究及诊治思路

对2011年3月～2012年5月我院急诊内科收治的以急性腹痛为主诉的82例患者,采集其临床资料进行回顾性分析。结果诊断正确率为84.15%(69/82),误诊率为15.85%(13/82)。其中内科疾病误诊率为8.70%(4/46),外科疾病误诊率为26.67%(8/30),妇科疾病误诊率为0.17%(1/6)。急诊医师应该对专业的医学诊断技术全面掌握并吸取、总结丰富的临床经验,做好疾病的诊断及鉴别诊断,防治误诊、漏诊的发生,提高临床治愈率。     

老年人急性腹痛137例临床分析

目的:探讨老年人急性腹痛的临床特点及病因,以提高对老年人急性腹痛的诊断率.方法:回顾性分析2000年1月至2009年12月我院急诊科以急性腹痛查因入院或留观的老年患者137例的临床资料.结果:腹内脏器病变疾病93例(67.8%),腹外疾病36例(26.3%),病因诊断不明8例(5.9%);误诊15例(10.9%),住院治疗79例(57.6%);死亡病例6例(4.3%).结论:老年人急性腹痛病因复杂,与主要疾病相关的症状体征不典型,过去史复杂,基础疾病多,并发症多,容易误诊.患者误诊率、住院率、死亡率高.     

成人急性非外伤性腹痛533例分析

目的分析急性非外伤性腹痛的临床特点,以期提高急性腹痛的诊疗水平。方法回顾性分析2008年1月至2010年1月急诊科接诊的533例成人急性非外伤性腹痛患者的临床资料。结果全组病例最后均确诊,其中腹腔内疾病503例(94.37%),腹腔外疾病30例(5.63%);内科腹痛303例(56.85%),外科腹痛197例(36.96%),妇科腹痛33例(6.19%)。前4位病因分别为急性胃肠炎、急性阑尾炎、泌尿系结石及消化性溃疡,分别为151例、64例、62例、55例,占总例数的62.29%。疾病早期误诊10例,误诊率为1.88%。全组死亡8例,病死率为1.5%,包括转上级医院后死亡4例。结论详细询问病史,仔细体格检查,合理安排辅助检查,加强科间合作,对急性腹痛诊断、治疗具有重要意义。早期不能确诊者,应留观,严密观察病情变化,有手术指征时,及时剖腹探查。     

内科急性腹痛的诊断分析

对我院2008年3月~2010年3月拟诊腹痛待查206例的病因和诊断步骤进行分析。结果腹腔内脏器官疾病178例(86.4%),腹腔外脏器疾病22例(10.7%),因妇科疾病导致急性腹痛6例(2.91%)。急性腹痛的病因复杂,初诊医生除对腹痛待查患者要高度重视。急诊内科医师应当掌握包括内外科及妇科领域的相关知识,充分利用各种辅助检查手段,以有效提高临床急性腹痛诊断准确率及治疗效果。     

腹腔外疾病引起急性腹痛315例的误诊分析

<正>急性腹痛根据病因可将其大体分为两类:腹腔内器官疾病、腹腔外器官以及全身性疾病。但一些腹腔外腹痛诊断比较困难、易误诊,有报道误诊率达34.62%[1],甚至引发患者死亡与医疗纠纷。现对2014年6月-2017年6月的315例腹痛患者进行分析,目的在于提高对腹腔外疾病导致腹痛的诊断水平。1临床资料     

腹型过敏性紫癜的诊断探讨

目的 探讨过敏性紫癜(Henoch-Schonlein Purpura,HSP)腹型的临床特征及早期诊断.方法 总结1993年2月至2006年2月收治的HSP 1002例临床资料,对其中41例腹型HSP进行回顾性分析.结果 ①41例腹型HSP占HSP总数的4.09%,男女比例2.42:1,平均年龄(24.88±18.96)岁;②发病前有明确诱因25例(60.98%);③主要表现腹痛(100%)、呕吐(56.10%)、便血(53.66%)、呕血(4.88%),腹部体征轻;④以消化道症状首发21例(51.22%),腹痛发生时间早于四肢紫癜,平均(14.79±7.03)d;⑤临床误诊率51.22%;⑥内镜正确诊断率88.57%.结论 腹型HSP患者表现剧烈腹痛而部位多变,腹部体征轻,早期急诊内镜检查有重要诊断价值.     

急性腹痛的病因诊断分析

目的 增加对腹痛疾病的认识和探讨腹痛疾病的病因及诊断程序.方法 回顾分析本院近2年门诊拟诊腹痛待查614例的病因和诊断步骤.结果 住院治疗患者269例(43.81%),其中以腹痛待查直接入院者98例(15.96%),门诊观察治疗345例(56.19%);病因中内科疾病351例(57.16%),外科疾病241例(39.25%),妇科疾病16例(2.60%)其他6例(0.98%).结论 急性腹痛的病因复杂,详细的病史,细心的体检,相关的实验室资料,必要的影像学检查及合理的综合分析仍然是建立正确诊断的最好方法.初诊医生对腹痛待查患者要高度重视鉴别诊断尤其是鉴别是否为外科腹痛.     

感染性荨麻疹腹痛与中性粒细胞/淋巴细胞比值及血小板/淋巴细胞比值的关系

目的分析急性荨麻疹腹痛患者在合并感染及无感染的情况下,超敏C-反应蛋白(hs-CRP)水平、中性粒细胞/淋巴细胞比值(NLR)、血小板/淋巴细胞比值(PLR)的变化与急性荨麻疹腹痛的关系。方法选取该院急性荨麻疹腹痛患者100例,按患者有无感染,分为感染性荨麻疹腹痛组(感染组)和非感染性荨麻疹腹痛组(非感染组),每组50例。另随机选取同期于该院就诊的其他原因导致的急性荨麻疹不伴腹痛患者50例作为对照组。测定3组患者的hs-CRP、NLR、PLR水平,利用受试者工作特征曲线(ROC曲线)进行灵敏度与特异度分析。结果感染组患者hs-CRP水平、NLR、PLR高于非感染组和对照组,差异均有统计学意义(P0.05),而非感染组和对照组各指标比较差异无统计学意义(P0.05)。hs-CRP用于感染性荨麻疹腹痛诊断的ROC曲线下面积(AUC)为0.997,最佳诊断值为13.56mg/L,灵敏度为96%,特异度为80%。NLR对感染性荨麻疹腹痛ROC曲线下AUC为0.843,最佳诊断值为17.67,灵敏度为70%,特异度为88%。PLR对感染性荨麻疹腹痛ROC曲线下AUC为0.974,最佳诊断值为224.85,灵敏度为94%,特异度为92%。结论 hsCRP、NLR和PLR水平对感染性荨麻疹腹痛的诊断均具有较高的灵敏度和特异度,值得进行临床推广使用。     

64排螺旋CT诊断急性肠梗阻

2009年11月～2011年2月我院收治并确诊的急性肠梗阻患者28例行64排螺旋CT检查,结果诊断结果1的肠梗阻病因诊断准确度为89.29%(25/28),诊断结果3为85.71%(24/28),诊断结果2为96.43%(27/28),诊断结果4为92.86%(26/28)。64排螺旋CT诊断急性肠梗阻具有很高的临床价值,能够有效提高肠梗阻诊断的准确率,是急性肠梗阻诊断的重要手段。     

超声诊断急性阑尾炎的临床分析

目的:探究分析在急性阑尾炎患者临床中采用超声诊断的价值。方法:本次研究对象为我院选取的120例急性阑尾炎患者,选取的患者经病理确诊为急性阑尾炎,患者的资料进行回顾性分析,对上述患者均采用彩色多普勒超声诊断检查,将超声诊断检查的结果与病理诊断的结果进行对比。结果:经手术病理诊断检查,120例患者均为急性阑尾炎疾病,其中急性单纯性阑尾炎45例,急性化脓性阑尾炎32例,急性坏疽阑尾炎28例,阑尾周围脓肿15例。采用彩色多普勒超声诊断检查,确诊118例为急性阑尾炎,诊断符合率为98.33%;118例急性阑尾炎疾病患者中,急性单纯性阑尾炎45例,占比100.00%(45/45),急性化脓性阑尾炎31例,占比96.88%(31/32),急性坏疽阑尾炎27例,占比96.43%(27/28),阑尾周围脓肿15例,占比100.00%(15/15)。结论:在急性阑尾炎患者临床诊断检查中,通过采用彩色多普勒超声诊断检查,能够有效提高患者的诊断符合率,患者的临床诊断效果显著,具有较高的临床应用价值。     

影响不典型阑尾炎超声诊断的Logistic二元回归分析

目的探讨导致不典型阑尾炎超声误诊及漏诊的影响因素。 方法回顾性分析被漏诊或误诊的急性不典型阑尾炎的临床、解剖及超声等特点,并进行二元因素赋值,通过Logistic回归分析比较以上因素对超声诊断阑尾炎影响。 结果经6步回归分析,发现大量肠气、右下腹积液、腹膜后位阑尾、右下腹局部回声增强是成人阑尾炎被超声误诊漏诊是主要原因,而肠系膜淋巴结显影及憩室炎是小儿阑尾炎误诊的主要因素（均P=0.000,且模型分类判对率均大于85%）。 结论右下腹回声增强、积液以及肠内气体干扰是导致超声误诊漏诊急性阑尾炎的主要原因,对于小儿急性右下腹痛应仔细鉴别其与肠系膜淋巴结炎及麦克尔憩室炎的区别。       

不典型主动脉夹层误诊的几点思考

目的分析临床表现不典型主动脉夹层（aortic dissection,AD）的误诊原因,并提出防范误诊的对策。方法对我院收治的2例临床表现不典型AD的临床资料进行回顾性分析。结果本组1例表现为腹腰痛在外院误诊为急性胰腺炎、急性胆囊炎等,1例因突发胸闷伴视物模糊入院误诊为冠心病,均经胸腹部CT确诊为AD,转上级医院治疗,1例病情好转出院,1例失访。结论 AD临床表现复杂多变缺乏特异性,首诊易误诊、漏诊,疑诊AD时仔细问诊和查体,及时选择相应的实验室和影像学检查,有利于提高早期诊断率,改善患者预后。     

妇科急腹症的临床鉴别及护理对策

目的 为尽早明确诊断，赢得抢救和治疗时机，减少误诊。方法 本文通过对我科1997年－2000年收治的388例妇科急腹症病人的临床资料进行回顾性分析。结果 388例病人包括10个病种，分4类：感染性疾病、腹腔内出血性疾病、肿瘤并发症及被误诊为妇科疾病的，其构成比为51．0％、45．3％、2．4％和1．3％，感染性疾病居第1位。手术治疗195例，占50．2％，内出血性疾病占90．2％。结论 出血性输卵管炎、异位妊娠、黄体破裂、急性阑尾炎容易互相误诊。因此，在诊断感染性疾病时应注意近期不洁同房史或宫腔手术史；内出血性疾病应重点询问月经史并监测hCG。后穹窿穿刺是简便而重要的鉴别诊断手段。护理对策：详细询问病史和进行全面的全身检查及妇科检查；密切观察生命体征变化、腹痛的部位、性质、特点以及腹痛与月经的关系；急诊工作程序化：正确处理抢救、治疗、护理3者间的程序关系；积极有效的对症护理是拯救病人生命的关键；健康教育是预防工作的一个重要环节，为病人提供安全的、经济的、高质量护理的保证。     

Acquired C1-esterase inhibitor deficiency: a rare cause of episodic acute abdominal pain and ascites.

C1-esterase inhibitor deficiency is a rare yet classic medical cause of acute abdominal pain mimicking a surgical emergency. A hereditary form and a very rare acquired form of the disease exist, and both give rise to a similar clinical syndrome despite a different pathogenic mechanism. We describe a typical case of acquired C1-esterase inhibitor deficiency in a 65-year-old woman presenting with recurrent acute abdomen and ascites who had undergone two negative surgical interventions before diagnosis was eventually established. Both the diagnostic and therapeutic approach to this rare condition should be known by emergency physicians for two reasons: (1) it may present as an acute abdominal emergency resulting in unnecessary surgical intervention; and (2) it may cause life-threatening upper airway obstruction as a result of laryngeal oedema.     

儿童克罗恩病5例临床误诊原因分析

【目的】总结儿童克罗恩病（Crohn＇s disease,CD）的临床特点,分析误诊原因,提高儿童CD的诊治水平。【方法】对2008-2010年我院收治5例CD患儿的临床资料进行回顾分析。【结果】5例CD患儿中,发病至确诊时间2周至11年,4例反复误诊。起病可急可缓,临床表现为腹痛、腹泻、生长发育迟缓、发热、口腔溃疡、肛周病变等。临床分型不一。影像学改变具有一定特征性。病理改变,破坏和慢性增殖改变并存,未发现非干酪样肉芽肿。随访9～16个月,均有不同程度缓解。【结论】儿童CD临床表现具有非特异性,起病急缓不一,误诊率高,综合临床表现、影像学和实验室检查,可以减少误诊,缩短确诊时间。     

Does computer-aided clinical decision support improve the management of acute abdominal pain? A systematic review

Acute abdominal pain is a common reason for emergency presentation to hospital. Despite recent medical advances in diagnostics, overall clinical decision-making in the assessment of patients with undifferentiated acute abdominal pain remains poor, with initial clinical diagnostic accuracy being 45-50%. Computer-aided decision support (CADS) systems were widely tested in this arena during the 1970s and 1980s with results that were generally favourable. Inception into routine clinical practice was hampered largely by the size and speed of the hardware. Computer systems and literacy are now vastly superior and the potential benefit of CADS deserves investigation. An extensive literature search was undertaken to find articles that directly compared the clinical diagnostic accuracy prospectively of medical staff in the diagnosis of acute abdominal pain before and after the institution of a CADS programme. Included articles underwent meta-analysis with a random-effects model. Ten studies underwent meta-analysis that demonstrated an overall mean percentage improvement in clinical diagnostic accuracy of 17.25% with the use of CADS systems. There is a role for CADS in the initial evaluation of acute abdominal pain, which very often takes place in the emergency department setting.     

23例肺血栓栓塞症临床特征分析

目的:探讨肺血栓栓塞症(PTE)早期临床特征、早期诊断手段,提高对急性PTE的诊断率。方法:回顾性分析2000年1月至2005年8月本院23例急性PTE患者的临床特征、辅助检查结果等资料。结果:呼吸困难(65%)、胸痛(36%)、晕厥(26%)、咯血(13%)等为急性肺血栓栓塞症最典型的早期表现。动脉血气分析、心电图、血浆D-二聚体、肺核素检查、核磁共振成像(MRI)检查为重要的诊断手段。结论:急性肺血栓栓塞症早期可无特异性临床表现,但对排除了其它原因的呼吸困难、胸痛等表现后,特别是血气分析有明显低氧血症而临床无法解释时应高度重视,应及早进行肺血栓栓塞症的相关检查,提高早期确诊率,以防误诊和漏诊。     

Acute fatal chest pain: optimized procedure in emergency department

Objective

To explore the diagnostic procedure of acute fatal chest pain in emergency department (ED) in order to decrease the misdiagnosis rate and shorten the definite time to diagnosis. The ultimate aim is to rescue the patients timely and effectively.

Methods

Three hundreds and two patients (56.9±11.8 Years, 72% men) complained with acute chest pain and chest distress presenting to our ED were recruited. They were divided into two groups according to visiting time (Group I: from October 2010 to March 2011, Group II: from October 2011 to March 2012). The misdiagnosis rate, definite time for diagnosis and medical expense were analyzed. Patients of Group I were diagnosed by initial doctors who made their diagnosis according to personal experience in outpatient service or rescue room in ED. While patients of Group II were all admitted to rescue room and were diagnosed and rescued according to the acute chest pain screening flow-process diagram. Differences inter-group was compared.

Results

The misdiagnosis rate of fatal chest pain in Group I and Group II was 6.8% and 0% respectively, and there was statistic difference (P=0.000). The definite time to diagnosis was 65.3 min and 40.1 min in control and Group II respectively, the difference had statistic significance (P=0.000). And the mean cost for treatment was 787.5/124.5 ¥/$ and 905.5/143.2 ¥/$ respectively, and there was statistic difference too (P=0.012).

Conclusion

Treating emergency patients with acute chest pain according to the acute chest pain screening flow-process diagram in rescue room will decrease misdiagnosis apparently, and it can also shorten the definite time to correct diagnosis. It has a remarkable positive role in rescuing patients with acute chest pain timely and effectively.

     

先天性胆总管囊肿18例误诊原因分析

目的：为提高小儿先天性胆总管囊肿诊治的水平,减少误诊误治。方法：收集10a间71例胆总管囊肿中18例误诊误治患儿资料。分析误诊误治的原因。结果：术前误诊的主要原因是对于出现黄疸,腹痛的患儿未能想到本病,强调避免误诊的方法是常规行上腹部B超初检,对特别疑难仍不能确诊的可借助于其他辅助检查,必要时术中胆道造影,直到确诊,结论：对黄疸,腹痛的患儿避免误诊的关键是要警惕本病。     

Spontaneous rupture of the spleen: a case report and literature review

Traumatic rupture of the spleen has been well described in the medical literature and is found in approximately 30% of patients undergoing surgery for blunt abdominal injury. Atraumatic splenic rupture is described much less often. A case of atraumatic rupture of an enlarged spleen is described. The etiology of spontaneous rupture of the spleen in this case could not be determined. The patient was seen and discharged twice from the emergency department; the diagnosis was made at emergency laparotomy three days after subsequent admission. This case should remind the emergency physician that nontraumatic splenic rupture should be considered in the differential diagnosis of unexplained acute left upper quadrant abdominal pain.