老年急性腹膜炎225例临床诊治分析  

Analysis of Clinical Diagnosis and Treatment for Elderly Acute Peritonitis:225 cases

作　　者：黄振元[1] 刘朝阳[2] 姜耕[2] 张彦[2] 

机构地区：[1]湖北中医药高等专科学校,湖北省荆州市434020 [2]湖北中医药高等专科学校附属医院外科

出　　处：《中国全科医学》2010年第30期3415-3416,共2页Chinese General Practice

摘　　要：目的分析老年急性腹膜炎患者的临床诊治特点。方法对225例老年急性腹膜炎患者临床表现、诊断、治疗、并发症及预后进行回顾性分析。结果老年急性腹膜炎继发于其他疾病219例(97.3%),其中以腹内脏器急性感染(占48.4%)和腹内脏器穿孔(占49.3%)多见,其临床表现不典型,39例(17.3%)漏诊。手术治疗186例患者,死亡16例,病死率为8.6%;39例患者保守治疗死亡8例,病死率为20.5%;两者病死率比较差异有统计学意义(P<0.05)。起病至手术时间不同的老年急性腹膜炎患者术后并发症发生率、病死率比较,差异均有统计学意义(P<0.05)。患者术前并存疾病数量不同,其术后并发症发生率、病死率比较,差异均有统计学意义(P<0.01)。结论老年急性腹膜炎患者就诊迟,临床表现不典型,且漏诊率高。术前并存疾病和手术延迟是影响疗效的主要因素。因此,早期诊断、早期治疗、早期手术、积极处理并存疾病是提高疗效的关键。Objective To analyze the character of clinical treatment for elderly acute peritonitis.Methods Analyze retrospectively the clinical feature,diagnosis,treatment,complications and prognosis of 225 patients with elderly acute peritonitis.Results Elderly acute peritonitis was secondary to other diseases （219 cases,account for 97.3%）,among which acute infection in viscera（48.4%） and perforation in viscera（49.3%） were the most common ones.The clinical feature of elderly acute peritonitis was not significant,for which 39 cases（17.3%）were missed diagnosis.16 cases died among the 186 cases who took surgery,and the fatality rate was 8.6%;8 cases died among the 39 cases who took expectant treatment,the fatality rate was 20.5%.The difference between the fatality rate is significant（P0.05）.The difference was significant between complication rate and fatality rate due to the different time between the disease onset and surgery（P0.05）.And the difference is significant between the complication rate and fatality rate due to different patients＇ diseases before surgery（P0.01）.Conclusion The patients with elderly acute peritonitis usually see doctors behind time,and the clinical manifestation is not typical,so the missed diagnosis rate is high.The pre-operation coexistence diseases and the delayed surgery are the main factors affecting the curative effect.The early diagnosis,early treatment,early surgery and the coexistence diseases treatment are the methods to enhance efficacy.

关 键 词：老年人 急性腹膜炎 诊断 治疗 

分 类 号：R656.41[医药卫生—外科学]