1533例急性非创伤性腹痛患者的分析

目的：对非创伤性腹痛的诊断情况进行分析总结,为此类疾病的救治积累经验。方法：选取2010-10-2013-10因腹痛收治于郑州大学第一附属医院急诊内科的患者为研究对象,对这些患者的诊断情况进行回顾性分析,并把腹痛按性质分为腹腔脏器病变与腹外脏器病变和全身疾病引起的腹痛,按诊断情况分为初诊即确诊的腹痛和初诊未被确诊的腹痛。记录各组病例的各种诱发因素、病因、症状、体征、辅助检查、发病及诊疗经过和最终的诊断情况,对各组疾病的例数及其所占的百分比进行统计分析。结果：共有1533例患者纳入本研究。收治于急诊内科的腹痛诊断有49种。初诊即确诊的腹痛共1 122例（占总例数73.19%）,全部为腹腔脏器病变。初诊未被确诊的腹痛共411例（26.81%）,其中腹腔脏器病变引起的腹痛共279例（18.20%）,腹外脏器病变引起的腹痛共65例（4.24%）,全身性疾病引起的腹痛共67例（4.37%）。本研究患者中,腹腔内脏器病变有1 401例,占所有腹痛病人的91.38%。共有10例患者死亡,其中2例死于主动脉夹层,1例死于铊中毒,1例死于胆道疾病,1例死于胃癌合并胰腺炎、肠梗阻;2例死于胰腺炎合并MODS,3例死于胃癌晚期,均发生在初诊未被确诊的腹痛患者。初诊即确诊的患者死亡率显著低于初诊未确诊的患者,为0：2.43%,P〈0.05,差异有统计学意义,说明初诊即确诊可降低患者死亡率。腹腔内脏器病变与非腹腔内脏器病变患者的死亡率比较为0.56%：0.72%,P〉0.05,差异无统计学意义,说明死亡率与疾病种类无关。结论：以腹痛为主要表现的疾病病因复杂,表现多样、特征不典型。腹腔脏器的病变,腹外脏器与全身性疾病均可以引起腹痛,诊断过程中要综合考虑各种因素。腹痛初诊较易诊断的疾病为腹腔脏器的病变所引起的疾病。初诊未被确诊的腹痛患者中,应重视腹外脏器病变和全身疾病引起的腹痛,这类疾病较少见,常被误诊,死亡率较高。

Diferential diagnosis of 1533 cases non-traumatic acute abdominal pain

Objective：To improve the diagnosis and differential diagnosis of non-traumatic acute abdominal pain.Method：A total of1533patients with non-traumatic acute abdominal pain were submitted to this study from October 2010to October 2013in the first affiliated hospital of Zhengzhou university.Clinical data including etiological factors,symptoms,physical signs,laboratory examinations,and the diagnosis of these patients were retrospectively analyzed,and the diagnostic procedure was divided into which the diagnosis of abdominal pain has been confirmed of first diagnosis and has not been confirmed.Result：A total of 1533patients were included in this study.There were 49kinds of diagnostic for the abdominal pain treated in our medical emergency,There were 1401cases intraabdominal viscera lesions,accounted for 91.38% of all patients in abdominal pain,a total of 411cases（26.81%）has not been confirmed of first diagnosis,a total of 279cases（18.20%）caused by intraabdominal viscera lesions,a total of 65cases（4.24%）caused by extrinsic abdominal viscera lesions,a total of 67cases（4.37%）caused by systemic diseases.A total of 10patients died,2cases died of aortic dissection,1case died of thallium poisoning,1case died of biliary tract disease,1case died of stomach cancer with pancreatitis and intestinal obstruction;2cases died of pancreatitis MODS,3cases died of gastric cancer,had occurred in both patients with abdominal pain has not been confirmed.The mortality rate was significantly lower in patients with diagnosed than undiagnosed,for 0：2.43%,P=0.00,statistically significant,so the diagnosis of abdominal pain has been confirmed of first diagnosis can reduce mortality.Intra-abdominal viscera lesions compared with mortality in other was0.56%,0.72%,P=0.816,no statistical difference,It is indicate the mortality rate has nothing to do with the kinds of etiology.Conclusion：The etiological factors of non-traumatic acute abdominal pain are various and complex,abdominal viscera lesions,extrinsic-abdominal viscera lesions,and systemic diseases can cause abdominal pain.And the abdominal viscera lesions were easier to diagnosis than extrinsic-abdominal viscera lesions,and systemic diseases,the later were rare and often misdiagnosed,mortality was higher.Emergency doctors should pay more attention to the differential diagnosis.