以腹痛为主要症状6例老年性不典型重症肺炎诊疗体会.docVIP

以腹痛为主要症状6例老年性不典型重症肺炎诊疗体会【中图分类号】 R725.6【文献标识码】B【文章编号】1672－3783(2011)04－0040－02 【摘要】目的：总结以腹痛为主要症状就诊的6例老年性重症肺炎诊疗体会，探讨老年性不典型重症肺炎发病机理，减少误诊误治。方法：对我院2009年2月-2011年4月间收治的6例以腹痛为主要症状就诊的老年性不典型重症肺炎患者的临床资料进行回顾性分析。结果：6例患者门诊初诊误诊率为66.67%，入院后经相关的理化检查，相继于0.5-1h内修正诊断，平均住院16.5d。结论：肺下部炎症波及到胸膜或膈肌外周部分引起上腹部疼痛，加之老年人各器官退行性改变、体反应力差、吸道症状不明显等，是老年性不典型重症肺炎容易误诊的主要原因。? 【关键词】腹痛 老年性肺炎 误诊误治 体会? The main symptoms of abdominal pain in 6 cases of severe atypical pneumonia in senile Diagnosis and Treatment? ji aimin? 【Abstract】 Objective: To summarize the main symptoms of abdominal pain as the treatment of severe pneumonia in 6 cases the diagnosis and treatment of senile experience, is not typical of age-related pathogenesis of severe pneumonia, reduce misdiagnosis. Methods: The hospital in February 2009 -2011 in April between the six cases were treated with abdominal pain as main symptoms of atypical treatment of elderly patients with severe pneumonia were retrospectively analyzed. Results: 6 patients with out-patient misdiagnosis rate was 66.67%, after admission by the relevant physical and chemical examination, within 0.5-1h have been modified in the diagnosis, average length of stay 16.5d. Conclusion: The lower part of pulmonary inflammation spread to the pleura, or diaphragm on the peripheral part of the cause of abdominal pain, in addition to degenerative changes in various organs elderly, physical response is weak and obvious symptoms of respiratory tract, are not typical of age-the main reason for misdiagnosis of severe pneumonia . ? 【Keywords】abdominal pain; elderly pneumonia; misdiagnosis; Experience 随着我国老年社会进程的进一步推进，老年人口的数据及患病率也在不断的攀升，老年社区获得性肺炎已成为临床上多发病、常见病［1］。然而，由于老年人机体退变、各种临床表现不典型，常导致误诊误治，特别是老年性不典型重症肺炎将无疑成为老年患者一重大危害性疾病。对临床医师的初诊诊断能力也是一个严峻的考验。现将我院以腹痛为主要症状就诊的6例老年性不典型重症肺炎的诊疗过程与体会汇报如下，意在于和同道一起交流，不断提高老年不典型肺炎诊疗水平。? 1临床资料? 1.1一般资料 本组6例患者，男性2例，女性4例。年龄均大于60周岁，符合2009年世界老年人年会规定的标准。6例老年患者均合并基础性疾病，其中，胆囊炎、胆结石3例；慢性阑尾炎2例；慢性阻塞性肺部疾病3例；冠心病2例；脑梗塞1例。6例患者中长期卧床者1例。? 1.2临床表现 6例患者首次就诊的主要症状