CAJ | 학술논문

目的：探讨以急腹症为首发表现的糖尿病的临床特点、误诊原因及防范措施。方法回顾性分析我院收治的以急腹症为首发表现误诊的糖尿病9例的临床资料。结果本组误诊率22.5%，误诊时间3 h~2 d。3例因腹痛、呕吐行腹部立位X线检查示肠管内有气液平误诊为急性肠梗阻；3例因腹泻、便常规有白细胞误诊为急性肠炎；2例因下腹疼、血白细胞升高及发热误诊为急性阑尾炎；1例因血尿淀粉酶均升高，腹部彩超检查示胰头显示不清，误诊为急性胰腺炎。9例按误诊疾病治疗均无效，后经仔细病史询问及血糖、尿糖、尿酮体及血气分析等检查，均确诊糖尿病酮症酸中毒，给予相应治疗皆症状好转出院。结论以急腹症为首发表现且病史不明确的糖尿病患者易误诊。加强对糖尿病及其并发症的认识，仔细病史询问，及时完善相关实验室检查，可减少糖尿病误诊误治。
목적：탐토이급복증위수발표현적당뇨병적림상특점、오진원인급방범조시。방법회고성분석아원수치적이급복증위수발표현오진적당뇨병9례적림상자료。결과본조오진솔22.5%，오진시간3 h~2 d。3례인복통、구토행복부립위X선검사시장관내유기액평오진위급성장경조；3례인복사、편상규유백세포오진위급성장염；2례인하복동、혈백세포승고급발열오진위급성란미염；1례인혈뇨정분매균승고，복부채초검사시이두현시불청，오진위급성이선염。9례안오진질병치료균무효，후경자세병사순문급혈당、뇨당、뇨동체급혈기분석등검사，균학진당뇨병동증산중독，급여상응치료개증상호전출원。결론이급복증위수발표현차병사불명학적당뇨병환자역오진。가강대당뇨병급기병발증적인식，자세병사순문，급시완선상관실험실검사，가감소당뇨병오진오치。
Objective To analyze the clinical features, reasons for misdiagnosis and precautionary measures in pa-tients with acute abdomen as the first symptom of diabetes. Methods Clinical data of 9 patients with acute abdomen as the first symptom of diabetes in our hospital was retrospectively analyzed. Results The misdiagnosis rate in the group was 22.5% and the misdiagnosis time was from 3 hours to 2 days. 3 cases with bellyache and vomiting up, whose upright abdomi-nal X-ray showed liquid-air interface in intestinal canal were misdiagnosed as acute intestinal obstruction;3 patients had diar-rhea and white blood cell in stool routine test, and were misdiagnosed as acute enteritis;2 cases had hypogastralgia, leukocy-tosis and a fever, and were misdiagnosed as acute appendicitis;1 case had hematuria increased amylase and unclear head of pancreas showed in abdominal color Doppler ultrasound, and was misdiagnosed as acute pancreatitis. It was ineffective for all the 9 patients treated as misdiagnosis disease. After being asked about medical history carefully, checked with blood glucose, urine glucose, urine ketone and blood gas analysis, they were diagnosed as diabetic ketoacidosis. After treated accordingly, 9 cases were all discharged with symptoms improvement. Conclusion The diabetes patients with acute abdomen as the first symptom and indeterminate medical history may be misdiagnosed easily. It can avoid misdiagnosis and missed treatments, if we reinforce the knowledge of diabetes and complications, ask medical history carefully and have the relevant laboratory tests in time.