CAJ | 학술논문

目的探讨急性出血性肠病的临床特点,以进一步指导临床实践.方法选择急性缺血性肠病25例,回顾性分析其临床表现、实验室检查、腹部增强CT及CTA、肠镜检查等特点.结果 25例急性缺血性肠病患者门诊首诊时症状分别为:腹痛20例(80％),腹胀16例(64％),腹泻18例(72％),呕吐13例(52％),便血6例(24％),脓血便8例(32％),稀水便7例(28％),发热11例(44％).首诊时体征特点为:腹部局限性压痛12例(48％),腹膜炎体征9例(36％),肠鸣音亢进7例(28％),肠鸣音减弱或消失5例(20％).首诊24 h内粪便常规潜血试验阳性率88％ (22/25).首诊后24h内血浆D-二聚体＞500 μg/L者占93％ (23/25).25例缺血性肠病确诊患者均为通过CTA检查确诊,同时1例肠镜检查示乙状结肠斑片状黏膜充血水肿,黏膜下淤血,部分肠段黏膜出血.结论高危患者出现剧烈腹痛、强烈的胃肠道排空症状、血D-二聚体明显升高伴粪潜血试验阳性的四联症应高度警惕缺血性肠病的可能,及时行腹部血管CTA及动脉造影检查,早期明确诊断,以免延误治疗的黄金时机.
목적 탐토급성출혈성장병적림상특점,이진일보지도림상실천.방법 선택급성결혈성장병25례,회고성분석기림상표현、실험실검사、복부증강CT급CTA、장경검사등특점.결과 25례급성결혈성장병환자문진수진시증상분별위:복통20례(80％),복창16례(64％),복사18례(72％),구토13례(52％),편혈6례(24％),농혈편8례(32％),희수편7례(28％),발열11례(44％).수진시체정특점위:복부국한성압통12례(48％),복막염체정9례(36％),장명음항진7례(28％),장명음감약혹소실5례(20％).수진24 h내분편상규잠혈시험양성솔88％ (22/25).수진후24h내혈장D-이취체＞500 μg/L자점93％ (23/25).25례결혈성장병학진환자균위통과CTA검사학진,동시1례장경검사시을상결장반편상점막충혈수종,점막하어혈,부분장단점막출혈.결론 고위환자출현극렬복통、강렬적위장도배공증상、혈D-이취체명현승고반분잠혈시험양성적사련증응고도경척결혈성장병적가능,급시행복부혈관CTA급동맥조영검사,조기명학진단,이면연오치료적황금시궤.
Objective To explore the clinical features of acute ischemic bowl disease in order to guide clinical treatment and avoid the severe complications.Methods 25 cases diagnosed as ischemic bowl disease were enrolled retrospectivly analysed the clinical features of symptoms,signs,laboratory test results,abbominal enhanced CT and CTA,enteroscopes of these patients.Results Among the 25 cases accorrding to first presentation of first contacts,the cardinal symptoms were spectively abdomial pain 20 (80％),abdomial distension 16 (64％),diarrhea 18 (72％),vomiting 13 (52％),hemafecia 6 (24％),bloody purulent stool 8 (32％),watery stool 7 (28％),fever 11 (44％) and physical signs were spectively local tenderness 12(48％),peritonitis sign 9(36％),active bowl sound 7 (28％),weak or disappeared bowl sound 5 (20％).22 of 25 cases were positive with ocult blood test of stool and 23 of 25 cases showed elevated D-dimer concentration(more than 500μg/L) within 24 hours after first contacts.All the 25 cases were dignosed with CTA and 1 case was performed with enteroscopy which showed that local mucosa of sigmoid colon was congestive,edema,submucosal extravasated blood and some part was bleeding.Conclusion The patient with high risk factors who suffered from the tetralogy of severe abdominal pain,intense evacuation symptoms,highly elevated D-dimer concentration and positive ocult blood test,is stongly suggested to be a ischemic bowl disease and should be performed the abdomial CTA or DSA examination in time to avoid missing the golden opportunity to cure.