103例缺血性肠病临床分析
发布时间：2018-10-15 15:22
【摘要】：目的通过对103例缺血性肠病的临床分析,提高对缺血性肠病的认识,以早期诊断,及时治疗。方法收集2009年1月至2015年12月期间宁夏医科大学总医院及海南省人民医院收治并确诊为缺血性肠病103例住院患者的病历资料,从性别、年龄、临床表现、原发疾病、实验室检验、影像学检查、治疗方法和疗效等方面,整理并统计数据,对缺血性肠病进行临床分析。结果1.一般资料103例缺血性肠病患者中,男性66例,女性37例,男女比1.783:1。发病年龄(28-79)岁,平均发病年龄(52.02±18.25)岁,60岁以上(含60岁)病例76例,占73.78%,40-60岁14例,占13.59%。2.个人史66例男性患者中38例吸烟(57.57%),34例饮酒(51.51%),吸烟、饮酒者28例(42.42%)。3.原发疾病原发性高血压34例(33.01%),冠心病20例(19.42%),糖尿病12例(11.65%),脑梗死2例(1.94%),慢性萎缩性胃窦炎2例(1.94%),高血脂3例(2.91%),类风湿关节炎1例(0.970%),患有高血压、冠心病2例(1.94%),患有高血压、糖尿病4例(3.88%)。4.诊断及分类急性肠系膜缺血(AMI)82例(79.61%),慢性肠系膜缺血(CMI)5例(4.85%),缺血性结肠炎(IC)12例(11.65%),未能明确类型的4例(3.88%)。5.临床表现103例缺血性肠病患者中,腹痛患者101例(98.05%),腹胀患者72例(69.90%),停止排便排气7例(6.79%),便血患者37例(35.92%),长期便秘患者6例(5.82%),恶心、呕吐31例(30.09%)。6.肠镜检查:6.1病变部位及表现103例缺血性肠病患者中48例行肠镜检查,结果示:病变累及肠段,肠黏膜充血、水肿,散在点状(片状、点片状)糜烂面及浅溃疡(浅小溃疡)形成,或提示肠壁黏膜的增厚、肠腔狭窄、局部充血明显或者呈阶段性的改变。病变部位以降结肠多见(40.69%),其次为乙状结肠(26.74%),升结肠(16.27%),直肠较少见。6.2病理结果病变黏膜慢性炎症或以炎症细胞浸润。7.实验室检验及影像学检查7.1检验D-二聚体升高者占60.86%,粪便潜血(OB)试验阳性患者占52.54%,余白细胞水平升高,白蛋白、红细胞比积水平均有不同程度的下降,但对本病的诊断无特异性。7.2检查103例患者中60例行腹部彩超检查,6例行腹部平片检查,46例行腹部CT检查,14例行CTA检查,53例行肠镜检查,其阳性率分别为18.33%(11/60),50.00%(3/6),45.65%(21/46),85.71%(12/14),79.24%(42/53)。8.治疗与转归103例患者中,77例患者经内科保守治疗,8例患者经内科治疗无效后行外科手术治疗,18例患者经外科手术治疗,其中2例死亡,余患者治疗均有效。结论缺血性肠病以老年男性患者多见,绝大多数伴有高血压、糖尿病、冠心病等原发疾病。临床表现缺乏特异性,主要以腹痛为首发症状,同时伴有不同程度的腹胀、腹泻、恶心、呕吐等胃肠道不适。D-二聚体、粪便潜血试验、CTA及肠镜检查对本病的诊断有一定的参考价值和意义。绝大多数以内科治疗为主,部分病例经外科手术治疗,疗效均好。
[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 卤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.
【学位授予单位】：宁夏医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R574
本文编号：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 卤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.
【学位授予单位】：宁夏医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R574
【参考文献】
相关期刊论文 前10条
1 王帆;林雪;马敏星;李瑾;;心血管相关疾病与老年人缺血性结肠炎的相关性研究[J];临床内科杂志;2015年06期
2 刘文徽;边祥兵;杨立;宋盛春;李军;石卉;万军;吴本俨;;急性肠系膜上动脉栓塞患者血管基础病变的CT影像分析[J];胃肠病学和肝病学杂志;2015年05期
3 蒋桂珠;钱厚福;马茂源;蔡小健;赵福军;;应用前列地尔治疗老年缺血性肠炎的效果分析[J];中国医师进修杂志;2014年35期
4 杨正德;王德宇;姚大鹏;付国静;李心红;;前列地尔注射液治疗老年非坏疽性缺血性结肠炎的初步探讨[J];内科急危重症杂志;2014年02期
5 汤义林;;评价血浆D-二聚体水平在急性缺血性结肠炎病人早期诊断价值[J];医学理论与实践;2013年23期
6 吴长才;舒建昌;;缺血性肠病诊断方法的研究进展[J];医学综述;2013年17期
7 罗国彪;杨绮红;;丹参注射液治疗缺血性肠病26例的疗效观察[J];中国药业;2013年12期
8 苏磊;刘一东;李雪松;;急性动脉缺血性肠病的早期诊断及治疗[J];中国普外基础与临床杂志;2013年04期
9 周晶;沈志祥;罗和生;;急性缺血性肠病66例临床分析[J];中国医师进修杂志;2012年19期
10 冯巨滨;;血浆D-二聚体检测在缺血性肠病患者诊断及预后中的价值[J];中国医药科学;2012年12期
，本文编号：2272959
本文链接：https://www.wllwen.com/yixuelunwen/xiaohjib/2272959.html
最近更新
教材专著
