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目的:对非创伤性腹痛的诊断情况进行分析总结,为此类疾病的救治积累经验。方法:选取2010-10-2013-10因腹痛收治于郑州大学第一附属医院急诊内科的患者为研究对象,对这些患者的诊断情况进行回顾性分析,并把腹痛按性质分为腹腔脏器病变与腹外脏器病变和全身疾病引起的腹痛,按诊断情况分为初诊即确诊的腹痛和初诊未被确诊的腹痛。记录各组病例的各种诱发因素、病因、症状、体征、辅助检查、发病及诊疗经过和最终的诊断情况,对各组疾病的例数及其所占的百分比进行统计分析。结果:共有1533例患者纳入本研究。收治于急诊内科的腹痛诊断有49种。初诊即确诊的腹痛共1 122例(占总例数73.19%),全部为腹腔脏器病变。初诊未被确诊的腹痛共411例(26.81%),其中腹腔脏器病变引起的腹痛共279例(18.20%),腹外脏器病变引起的腹痛共65例(4.24%),全身性疾病引起的腹痛共67例(4.37%)。本研究患者中,腹腔内脏器病变有1 401例,占所有腹痛病人的91.38%。共有10例患者死亡,其中2例死于主动脉夹层,1例死于铊中毒,1例死于胆道疾病,1例死于胃癌合并胰腺炎、肠梗阻;2例死于胰腺炎合并MODS,3例死于胃癌晚期,均发生在初诊未被确诊的腹痛患者。初诊即确诊的患者死亡率显著低于初诊未确诊的患者,为0:2.43%,P<0.05,差异有统计学意义,说明初诊即确诊可降低患者死亡率。腹腔内脏器病变与非腹腔内脏器病变患者的死亡率比较为0.56%:0.72%,P>0.05,差异无统计学意义,说明死亡率与疾病种类无关。结论:以腹痛为主要表现的疾病病因复杂,表现多样、特征不典型。腹腔脏器的病变,腹外脏器与全身性疾病均可以引起腹痛,诊断过程中要综合考虑各种因素。腹痛初诊较易诊断的疾病为腹腔脏器的病变所引起的疾病。初诊未被确诊的腹痛患者中,应重视腹外脏器病变和全身疾病引起的腹痛,这类疾病较少见,常被误诊,死亡率较高。
OBJECTIVE: To analyze and summarize the diagnosis of non-traumatic abdominal pain and gain experience in the treatment of such diseases. Methods: 2010-10-2013-10 selected for the treatment of abdominal pain in the First Affiliated Hospital of Zhengzhou University, Department of Emergency Medicine as the research object, the diagnosis of these patients were retrospectively analyzed, and the abdominal pain by nature is divided into abdominal viscera lesions And abdominal viscera lesions and systemic disease caused by abdominal pain, according to the diagnosis is divided into newly diagnosed abdominal pain and newly diagnosed abdominal pain was not diagnosed. The evoked factors, etiology, symptoms, signs, auxiliary examinations, onset and diagnosis of the patients were recorded and the final diagnosis was recorded. The number of cases and the percentage of each group were statistically analyzed. Results: A total of 1533 patients were included in this study. 49 cases of abdominal pain admitted to the emergency department of internal medicine diagnosis. A total of 1 122 cases of newly diagnosed abdominal pain (73.19% of the total number of cases), all of abdominal disease. A total of 411 cases (26.81%) of newly diagnosed abdominal pain were diagnosed. There were 279 cases (18.20%) of abdominal pain caused by abdominal viscera lesions, 65 cases (4.24%) of abdominal pain caused by extra-abdominal organ diseases, systemic diseases A total of 67 cases of abdominal pain (4.37%). Among the patients in our study, 1 401 cases of intra-abdominal organ lesions accounted for 91.38% of all abdominal pain patients. A total of 10 patients died, of which 2 died of aortic dissection, 1 died of thallium poisoning, 1 died of biliary disease, 1 died of gastric cancer with pancreatitis, intestinal obstruction; 2 died of pancreatitis combined with MODS, 3 patients died of advanced gastric cancer, have occurred in newly diagnosed abdominal pain patients. The mortality rate of the newly diagnosed patients was significantly lower than that of the newly diagnosed patients (0: 2.43%, P <0.05). The difference was statistically significant, which indicated that the initial diagnosis of patients could reduce the mortality rate. The intra-abdominal organ lesions and non-abdominal visceral lesions in patients with mortality compared to 0.56%: 0.72%, P> 0.05, the difference was not statistically significant, indicating that the mortality rate has nothing to do with the type of disease. Conclusion: The causes of abdominal pain as the main manifestation of the complex disease, the performance of diverse features atypical. Abdominal viscera lesions, abdominal organs and systemic diseases can cause abdominal pain, the diagnosis process to consider a variety of factors. The first diagnosis of abdominal pain is easier to diagnose the disease caused by the lesions of the abdominal organs. Newly diagnosed abdominal pain patients, should pay attention to abdominal abdominal disease and systemic disease caused by abdominal pain, such diseases are rare, often misdiagnosed, higher mortality.