关于以下消化道大出血为首发症状的克罗恩病的诊断和治疗.pdf

关于以下消化道大出血为首发症状的克罗恩病的诊断和治疗 【摘要】目的探讨以下消化道大出血为首发症状的克罗恩病的诊断和治疗。 方法 回顾性分析1 例该病患者的临床资料，并对相关文献进行复习和总结。结 果 采取输血和支持疗法，静脉输注生长抑素，稳定生命体征后，行电子结肠镜 及病理组织学检查，明确诊断为克罗恩病。用皮质激素和柳氮磺胺吡啶治疗后 痊愈出院。结论 当下消化道大出血作为克罗恩病的首发症状，而肠道症状很不 典型或缺乏时，结肠镜检查有重要价值。生长抑素有利于止血，皮质激素和柳 氮磺胺吡啶仍为治疗克罗恩病的主要药物。 【关键词】克罗恩病；胃肠出血；诊断；治疗 Abstract: Objective To investigate the strategy in the diagnosis and treatment of Crohn disease that represents lower gastrointestinal tract massive hemorrhage as the first symptom. Methods A case of Crohn disease successfully diagnosed and treated was reported here， with the pertinent literature reviewed. Results Blood transfusion and supportive therapy with somatostatin iv gt were administered. When the vital signs were stabilized， electronic colonoscopy and histopathologic examination were performed to establish the final diagnosis of Crohn disease. Following a course of standard adrenocortical hormone and SASP therapy， the patient fully recovered from illness. Conclusion Coloscopy is valuable for diagnosing the Crohn disease that represents massive hemorrhage of lower gastrointestinal tract as the first symptom， especially in case the intestinal symptoms are lacking or atypical. Somatostatin is effective for treating alimentary tract hemorrhage， but adrenocortical hormone and SASP are still the principal medicines for Cohn disease. Key words： Crohn disease； gastrointestinal hemorrhage； diagnosis； treatment 克罗恩病(Crohn disease， CD)是一种原因不明的胃肠道慢性炎性肉芽肿 性疾病，可侵犯消化道任一部位。其临床缺乏特异性表现，除消化道症状外， 还常累及肠外多个系统，症状多样化［1］。但以下消化道大出血为首发症状的 克罗恩病罕见。我科收治1 例，现报道如下，并对相关文献进行复习和总结， 探讨该病的诊断和治疗。 1 临床资料 患者，男性，24 岁，因突发便血3 h 伴晕厥1 次入院。患者入院前3 h 无 诱因解3 次鲜红色水样便，其中有大量暗红色血块，总量约1 500 ml，无腹 痛及呕血，感胸闷、头晕、乏力、大汗淋漓，晕厥1 次，家人急送我院。既往 无反复腹痛、腹泻、便血和发热史，无结核及消化性溃疡史。 入院体检：体温36.5℃，呼吸33 次/min，心率130 次/min，血压80/50 mmHg(1 mmHg=0.133 kPa)，神志恍惚，躁动，面色苍白，重度贫血貌，无黄染， 皮肤黏膜无淤点及淤斑。心肺正常，腹部平软、无压痛及包块，肝脾肋下未及， 移动性浊音阴性，肠鸣音6~7 次/min。实验室检查：血红蛋白56 g/L，血小板 210×109/L， 红细胞2.35×1012/L，白细胞4.5×1