CAJ | 학술논문

目的通过酚麻美敏治疗成人上呼吸道感染(upper respiratory tract infection,URTI)所致急性腹痛的回顾性分析,提高急诊医师对成人URTI致急性腹痛患者的鉴别能力,减少误诊误治.方法回顾性分析2010年1月至2011年12月2年间,于北京大学第三医院急诊科就诊的成人URTI,以急性腹痛作为主要临床表现,或仅以急性腹痛作为临床表现者,共58例,提取病史、症状体征、辅助检查及给药过程.根据首次诊断正确与否,分为诊断正确组和误诊组.诊断正确组给予酚麻美敏片治疗;误诊组给予山莨菪碱及抗感染或改善心肌缺血治疗等,未给予抗URTI治疗,8 ～48 h后给予酚麻美敏片治疗.观察两组患者治疗转归.结果诊断正确组28例,27例于服用酚麻美敏片2～3h后腹痛症状缓解或消失,有效率96％;误诊组30例,经山莨菪碱及抗感染或改善心肌缺血等治疗,2例表现为急性胃肠炎症状者缓解,有效率7％;余28例患者腹痛持续8 ～48 h后,加用酚麻美敏片,经2～3 h后腹痛症状均明显减轻或消失,有效率100％.结论成人URTI可致急性严重腹痛,酚麻美敏片对成人URTI所致急性腹痛具有显著治疗效果.
목적 통과분마미민치료성인상호흡도감염(upper respiratory tract infection,URTI)소치급성복통적회고성분석,제고급진의사대성인URTI치급성복통환자적감별능력,감소오진오치.방법 회고성분석2010년1월지2011년12월2년간,우북경대학제삼의원급진과취진적성인URTI,이급성복통작위주요림상표현,혹부이급성복통작위림상표현자,공58례,제취병사、증상체정、보조검사급급약과정.근거수차진단정학여부,분위진단정학조화오진조.진단정학조급여분마미민편치료;오진조급여산랑탕감급항감염혹개선심기결혈치료등,미급여항URTI치료,8 ～48 h후급여분마미민편치료.관찰량조환자치료전귀.결과 진단정학조28례,27례우복용분마미민편2～3h후복통증상완해혹소실,유효솔96％;오진조30례,경산랑탕감급항감염혹개선심기결혈등치료,2례표현위급성위장염증상자완해,유효솔7％;여28례환자복통지속8 ～48 h후,가용분마미민편,경2～3 h후복통증상균명현감경혹소실,유효솔100％.결론 성인URTI가치급성엄중복통,분마미민편대성인URTI소치급성복통구유현저치료효과.
Objective To discuss the problem of upper respiratory tract infection presenting various clinical manifestations in adults thereby likely making misdiagnosis and to put forth the patients with the symptom of acute abdominal pain as examples in order to caution emergency physicians to avoid misdiagnosis and mistreatment.Methods Data of 58 adult patients with upper respiratory tract infection were collected from January 2010 to December 2011.The chief complain of these patients was acute abdominal pain.After analysis of data including clinical history,symptoms and signs,laboratory findings and medication,patients were divided into two groups post hoc:correctly diagnosed group (group A) and misdiagnosed group (group B).In group A,anti-chill medicine such as tylenol cold tablets (a compositus of paracetamol,pseudoephedrine hydrochloride,dextromethorphan and chlorpheniramine) was given to patients,while in group B,anisodamine (muscarine cholinergic blocker) and antibiotics were given instead of anti-chill medicine.The anti-chill medicine such as tylenol cold tablets would be given to patients of group B when abdominal pain was not released 8-48 hours after treatment.The course of treatment and outcome of patients in the two groups were observed.Results Of 28 patients in group A,27 had abdominal pain relieved or disappeared 2-3 hours after treatment and only 1 patient had abdominal pain lasted 12 hours after treatment.Of 30 patients in the group B,only 2 patients presenting the symptom of acute gastroenteritis got totally relived 2-3 hours after treatment,while the rest of 28 patients did not get rid of abdominal pain,or only had brief period of painlessness after anisodamine injection.Alternatively,8-48 hours later as Tylenol Cold Tablets was given to patients of group B,the abdominal pain was relieved or disappeared after 2-3 hours without recurrence in 2-48 hours.Conclusions Upper respiratory tract infection manifests diversely in adults,and acute abdominal pain could be a main clinical manifestation.Anti-chill medicine,such as tylenol cold tablets,has a noticeably therapeutic effect for acute abdominal pain caused by upper respiratory tract infection in adults,while anisodamine injection makes poor efficacy.